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Occupational therapy services in early childhood and school-based settings

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Occupational Therapy Services in
Early Childhood and School-Based Settings
The primary purpose of this document is to describe how occupational therapy supports
children’s and youth’s learning and development in early childhood and school-based settings.
This document is intended for occupational therapists and occupational therapy assistants in
practice, academia, research, advocacy, and administrative positions. Other audiences for this
statement include regulatory and policymaking bodies, provider groups, accreditation agencies,
other professionals, and the general public who may be seeking clarification about occupational
therapy’s scope of practice and domain of concern related to this topic. The American
Occupational Therapy Association (AOTA) provides information and resources to support
occupational therapists and occupational therapy assistants in the delivery of effective services
for children and youth in a variety of settings, including school-based and early intervention
programs, child care, Head Start and Early Head Start, preschool and pre-kindergarten programs,
and at home.
Occupational therapists and occupational therapy assistants1 work with children and youth,
parents, caregivers, educators, and other team members to facilitate children’s and youth’s ability
to participate in everyday activities, or occupations. Occupations are “activities…of everyday
life, named, organized, and given value and meaning by individuals and a culture” (Law,
Polatajko, Baptiste, & Townsend, 1997, p. 34). Occupations are meaningful for the child and are
based on social or cultural expectations or peer performance. In early childhood (birth–8 years of
age) and school-based settings, occupational therapy practitioners2 use their unique expertise to
help children and youth with and without challenges prepare for and perform important learning and
developmental activities within their natural environment. Occupational therapy services support a
child’s participation in activities of daily living (ADLs), instrumental activities of daily living
(IADLs), education, work, play, leisure, rest and sleep, and social participation.
Occupational therapists have knowledge and skills in the biological, physical, social, and
behavioral sciences to evaluate and intervene with individuals across the life course.
Occupational therapy practitioners apply evidence-based research ethically and appropriately to
the evaluation and intervention process following professional Standards of Practice (AOTA,
2010b) and the Occupational Therapy Code of Ethics and Ethics Standards (AOTA, 2010a).
1Occupational therapists are responsible for all aspects of occupational therapy service delivery
and are accountable for the safety and effectiveness of the occupational therapy service delivery
process. Occupational therapy assistants deliver occupational therapy services under the
supervision of and in partnership with an occupational therapist (AOTA, 2009).
2When the term occupational therapy practitioner is used in this document, it refers to both
occupational therapists and occupational therapy assistants (AOTA, 2006).
Early Intervention & Schools Statement
The American Occupational Therapy Association
Legislative Influences on Service Delivery
Occupational therapy practice in schools and early childhood settings is affected by many federal
and state laws and regulations, as well as local policies and procedures. Table 1 summarizes
some of the policies that directly affect the provision of occupational therapy for children and
youth. Additional information about these laws is provided in Occupational Therapy Services for
Children and Youth Under IDEA (Jackson, 2007).
AOTA believes that occupational therapy practitioners working in early childhood and school
settings should have working knowledge of the federal and state requirements to ensure that their
program policies are in compliance. Occupational therapy practitioners also should be familiar
with their state’s occupational therapy practice act and related rules and regulations to ensure that
occupational therapy services are provided accordingly.
Table 1. Federal Laws and Their Influence on Occupational Therapy Services
Law Influence on Occupational Therapy Services
Individuals with
Disabilities Education
Improvement Act
(IDEA), P.L. 108-446
Federal legislation that specifically includes occupational therapy as a related
service for eligible students with disabilities, ages 3–21 years, to benefit from
special education (Part B) or as a primary service for infants and toddlers who
are experiencing developmental delays (Part C).
IDEA may be reauthorized and amended in 2011.
Elementary and
Secondary Education
Act (ESEA)
Amendments, No Child
Left Behind Act
(NCLB), P.L. 107-110
Federal legislation that requires public schools to raise the educational
achievement of all students, particularly those from disadvantaged
backgrounds, students with disabilities, and those with limited English
proficiency, and that states establish high standards for teaching and student
learning. While not specifically mentioned in the statute, occupational therapy
is generally considered to be a pupil service under ESEA.
ESEA may be reauthorized and amended in 2011.
Section 504 of the
Rehabilitation Act of
1973, as amended, 29
U.S.C. 794; Americans
with Disabilities Act
(ADA, as amended);
Americans with
Disabilities Act
Amendments Act of
2008 (ADAAA), P.L.
110-325
Civil rights statutes that prohibit discrimination on the basis of disability by
programs receiving federal funds (Section 504) and by services and activities
of state and local government (ADA and ADAAA). Disability here is defined
more broadly than in IDEA. Children and youth who are not eligible for IDEA
may be eligible for services under Section 504 or the ADA, such as for
environmental adaptations and other reasonable accommodations, to help them
access and succeed in the learning environment. Each state or local education
agency determines eligibility procedures for children and youth served under
Section 504 or the ADA.
Title XIX of the Social
Security Act of 1965, as
amended; Medicaid, P.
L. 89-97
Federal–state match program that provides medical and health services for
low-income children and adults. Occupational therapy is an optional service
under the state plan but mandatory for children and youth under the Early
Periodic Screening, Diagnosis and Treatment (EPSDT) services mandate.
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Early Intervention & Schools Statement
The American Occupational Therapy Association
Occupational therapy services provided in early intervention programs are
frequently covered by Medicaid. School-based services also may be covered
by Medicaid but also must meet applicable medical necessary requirements as
well as be educationally relevant.
Improving Head Start
for School Readiness
Act of 2007, P.L. 110-
134
Federal program that provides comprehensive child development services to
economically disadvantaged children (ages birth–5 years) and their families,
including children with disabilities. Early Head Start serves children up to 3
years of age. Occupational therapy may be provided in these settings under the
Head Start requirements or under IDEA.
Assistive Technology
Act of 2004, P.L. 108-
364, as amended
Federal program that promotes access to assistive technology for persons with
disabilities so that they can more fully participate in education, employment,
and daily activities.
U.S. Department of
Agriculture Food and
Nutrition Service
(USDA, 2001)
National School Breakfast and Lunch Programs are required to provide food
substitutions and modifications of school meals for students whose disabilities
restrict their diets, as determined by a doctor.
Occupational Therapy Domain and Process
Occupational therapy supports client health and participation in life through engagement in
occupations (AOTA, 2008). Occupational therapy focuses on the following occupations: ADLs,
IADLs, education, leisure, play, social participation, work, and rest and sleep.
Occupational therapy practitioners provide services that enable children and youth to organize,
manage, and perform their daily life occupations and activities. For example, a middle-school-
age child with physical limitations may have difficulty completing written work. The
occupational therapy practitioner collaborates with the student, parents, and educators to identify
the skills of the student, the demands of the environment, and appropriate solutions for
interventions. Another example is the family of a newborn baby with poor feeding skills. The
occupational therapist may provide training and support for the family to enhance the baby’s
ability to drink from a bottle.
In early childhood and school-based practice, occupational therapy clients include individuals
(e.g., child, family, caregivers, teachers), organizations (e.g., school districts, community
preschools, Head Start), and populations within a community (e.g., homeless children, children
at risk for social–emotional difficulties). Occupational therapy services are directed toward
facilitating the client’s participation in meaningful occupations that are desired and important in
the school, family, and community contexts.
Occupational therapy services include evaluation, intervention, and documenting outcomes.
During the evaluation, the occupational therapist gains an understanding of the client’s priorities
and his or her problems when engaging in occupations and activities. Evaluation and intervention
address factors that influence occupational performance, including
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Early Intervention & Schools Statement
The American Occupational Therapy Association
Performance skills (e.g., motor and praxis skills, sensory–perceptual skills, emotional
regulation skills, cognitive skills, communication and social skills);
Performance patterns (e.g., as habits, routines, rituals, roles);
Contexts and environments (e.g., physical, social, cultural, virtual, personal, temporal);
Activity demands (e.g., required actions, body functions); and
Client factors (e.g., values and beliefs; mental, neuromuscular, sensory, visual, perceptual,
digestive, cardiovascular, and integumentary functions and structures).
Desired outcomes are identified to guide future actions with the client. They also are a means for
evaluating the effectiveness of occupational therapy services.
Occupational Therapy Service Provision
Occupational therapy practitioners provide early childhood services in children’s homes, child
care centers, preschools, Early and Head Start programs, early intervention programs, and
clinical settings. Occupational therapy practitioners provide school-based services in both public
and private facilities. Funding sources for occupational therapy services vary and may include
federal and state funding (e.g., funding through state agencies, Medicaid), insurance, and self-
pay.
Children and adolescents may be served under the Individuals with Disabilities Education Act
(IDEA) Part C, if they are ages 3 years or younger, or Part B, if they are between the ages of 3
and 21 years. Some states are extending their Part C program to include preschool-age children.
Early Intervention (IDEA Part C; Birth Through Age 2 Years)
Early intervention occupational therapy services are provided to infants and toddlers with
developmental delays, with diagnosed physical or mental conditions, or who are at risk for
having a developmental delay in order to enhance the family’s ability to care for their child with
a disability. To be eligible for early intervention services under Part C, a child must have a delay
in one or more of five developmental areas: (1) physical (including vision and hearing), (2)
cognitive, (3) communication, (4) social–emotional, and (5) adaptive. When evaluating infants or
toddlers, the occupational therapist considers aspects of the child’s performance that are
strengths or barriers to participation within the natural environment and daily routines. The
occupational therapist’s knowledge of brain development, assessment, and intervention across
developmental domains, early literacy, and feeding/eating skills enables them to work with
children with disabilities and their families. Infants and toddlers with significant medical or
developmental concerns (e.g, feeding, neurological) should receive services from trained
professionals, as they are vulnerable and require ongoing evaluation.
IDEA requires that child and family outcomes and services be developed in collaboration with
the child’s caregivers, other members of the team, and community agencies. These services
become part of the individualized family service plan (IFSP). Some examples of occupational
therapy services for the five developmental domains are listed in Table 2.
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Early Intervention & Schools Statement
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Table 2. Occupational Therapy’s Role in Early Intervention Developmental Areas
Developmental Area Occupational Therapy’s Role
Adaptive Promote independence in self-care, such as eating and
drinking, dressing, and grooming; collaborate with parents
about safe positioning and modification of food textures to
enhance eating
Cognitive Promote ability to notice and attend to objects and people in
the environment; promote ability to sort and classify objects
and to generalize learning to new daily living tasks; promote
ability to sequence steps to complete daily living occupations
Communication Facilitate language development through social interactions,
assistive communication devices, switches, toys
Physical Promote movement for exploration of the environment,
facilitate use of arms and hands to handle and manipulate
objects, educate caregivers in handling and positioning
techniques
Social–emotional Foster self-regulation, social participation, and play through
interactions with peers and adults
In Part C programs, occupational therapy is a primary service. The occupational therapist may be
the sole service provider but most often is part of a collaborative team that works to enhance the
family’s capacity to care for the child’s health and development within daily routines and natural
environments. An occupational therapist may serve as the service coordinator to monitor the
implementation of the IFSP and coordinate services with other team members and agencies.
When the child is turning 3 years of age, the occupational therapist works collaboratively with
the IFSP team to transition children to appropriate community-based programs or to preschool
special education services, as applicable.
School Age (IDEA Part B; Ages 3–21 Years)
The local school district is responsible for determining whether school-age children and youth
with disabilities, including preschool children from ages 3 to 5 years, qualify for special
education and related services under IDEA Part B (§602(3)(A)(ii)). A full and individual
evaluation is conducted, and an individualized education program (IEP) is developed if the
student is eligible for services. Students with disabilities may be eligible for IDEA if they meet
one or more of 10 disability categories:
1. Mental retardation;
2. Hearing impairments, including deafness;
3. Speech or language impairments;
4. Visual impairments, including blindness;
5. Serious emotional disturbance;
6. Orthopedic impairment;
7. Autism;
8. Traumatic brain injury;
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Early Intervention & Schools Statement
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9. Other health impairment; or
10. Specific learning disabilities (see §602(3)(A)).
Occupational therapy is one of the related services that may be provided to IDEA-eligible
students who are receiving special education in schools; homes; hospitals; and other settings,
including juvenile justice and alternative education settings. Related services are “transportation,
and such developmental, corrective, and other supportive services (including…occupational
therapy)…as may be required to assist a child with a disability to benefit from special education,
and includes early identification and assessment of disabling conditions in children” (see
§602(26)(A)). As such, occupational therapy is a support service for students and teachers.
When an occupational therapy evaluation is required, data collection is focused on identifying
the academic, developmental, and functional needs of the student (see §614(d)(3)(A)(iv)).
Information is sought regarding the student’s strengths and factors that may be interfering with
his or her learning and participation in the context of the educational activities, routines, and
environments. Observations are made where and when difficulties occur at school (i.e., at the
times and in the location in which the student normally engages in the activities and is
demonstrating behaviors that are of concern). These locations include the classroom, hallways,
cafeteria, restrooms, gym, and playground. The student’s work, participation, and behaviors are
compared with other students in the same environments and situations. Curricular demands and
existing task and environmental modifications are reviewed.
Interviews with instructional personnel, the student, and family members are conducted to gather
information about the student’s participation and performance. Cultural differences that may
exist between home and school are explored. Existing special education supports and services,
including strategies utilized to improve performance, are reviewed. Practices consistent with
universal design for learning (UDL) guidelines (CAST, 2008) and the availability of assistive
technologies to support school performance are assessed. Standardized testing may be conducted
when needed to gather additional data.
Occupational therapy evaluation results then are shared with the parents and the
multidisciplinary IEP team. According to Nolet and McLaughlin (2005), decisions about an IEP
are individualized but “start from the expectation that the student is to learn the general
education curriculum, and special education’s role is to help the student learn and progress in
that curriculum” (p. 14). Annual goals for special education instruction are determined by the
IEP team, as well as the accommodations and services and supports required to help the student
access and progress in the general curriculum. Occupational therapy practitioners collaborate
with the IEP team regarding the educational need for occupational therapy services.
On the basis of current occupational therapy evaluation data; the occupational therapist’s
professional judgment; and other available information about the student’s skills, abilities, goals,
and objectives to be achieved, the IEP team decides whether occupational therapy services are
needed. The development of the IEP is a collaborative process with participation from all team
members. The team determines when the student goals need the expertise of an occupational
therapy practitioner, as well as the amount of time, frequency, duration, and location of those
services. The team meets regularly (at least annually) to assess whether the student is making
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Early Intervention & Schools Statement
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progress toward achieving his or her goals and whether special education and/or related services
(including occupational therapy) need to be continued, modified, or discontinued.
Intervention can be directed toward individuals (including teachers and other adults working
with the child), groups, environmental factors, and programmatic needs (see Table 3). According
to Brannen et al. (2000), effective implementation includes consultation, collaboration, and
teamwork. Throughout the intervention process, the occupational therapy practitioner works
collaboratively with the client and other team members such as family members, instructional
personnel, school administrators, and private practitioners who may serve the student.
Interventions are respectful of the customs, beliefs, activity patterns, behavior standards, and
expectations accepted by the society of which the client is a member. Along with the provision
of strategies and techniques that assist the child with making progress, education and training of
other team members also is an important service that occupational therapy practitioners provide.
Interventions are provided in natural school environments (e.g., classroom, playground,
cafeteria), occurring in the time and place that is most beneficial for the student. As noted in
Hanft and Shepherd (2008), the primary setting for occupational therapy services incorporates
daily routine and contexts important to the student.
Table 3. Occupational Therapy Services and Supports for Students 3–21 Years Under
IDEA Part B
IDEA Part B
Performance Areas Occupational Therapy Services and Supports
Academic Provide consultation with curriculum planners to support academic
achievement by identifying needed curriculum accommodations and
modifications for standardized testing; suggest adaptations to
curriculum materials, methods, processes, and production; identify and
provide needed transition supports and services targeting post-
secondary goals
Developmental Foster development of pre-academic skills, including prewriting and
pre-scissor skills; toileting skills; eating and drinking skills; dressing
and grooming tasks; communication skills; management of sensory
needs; social skills
Functional Facilitate use and management of school-related materials, daily
routines/schedule, written school work, task/activity completion,
transitions among activities and persons, adherence to rules, self-
regulation, interactions with peers and adults, participation in leisure
and recreational occupations at home, school, and the community; use
of adaptive and assistive technology to support participation and
performance
Assist school in locating driver education training for students with
disabilities. Collaborate with family and school staff in the
development and implementation of transition programs, including
preschool and high school transition. Collaborate with school personnel
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Early Intervention & Schools Statement
The American Occupational Therapy Association
in the design and implementation of positive mental health programs
and positive behavioral support systems
Outcomes are measured by student achievement of the IEP goals and other educational
objectives such as curriculum expectations. Outcome measurement for instruction may include
participation on national, state, and/or district-wide assessments that are supported by services
provided by the occupational therapy practitioner. Outcome measurement for occupations such
as self-care, play, leisure, social participation, and work transition that typically are addressed by
occupational therapy practitioners in the school setting is accomplished by monitoring progress
on IEP goals focused on these areas. Data collected on identified outcomes is reviewed by the
IEP team to assist with determining present levels of academic achievement and functional
performance and is reported during the required annual review.
Section 504/Americans with Disabilities Act
Section 504 of the Rehabilitation Act prohibits discrimination on the basis of disability for any
program receiving federal funds, including schools, early intervention, and Head Start programs.
The Americans with Disabilities Act also prohibit discrimination on the basis of disability in
education, employment, transportation, health care, and a host of other services and activities of
state and local governments, including child care. Students with disabilities who are not eligible
for services under IDEA may be eligible under Section 504 or the ADA if the disability is such
that it significantly limits “one or more major life activities.” Examples include students who
have HIV/AIDS, asthma, arthritis, attention deficit disorder/attention deficit hyperactivity
disorder, traumatic brain disorder, conduct disorder, or depression.
Occupational therapists may be asked to help local school district teams determine student
eligibility under Section 504 and to assist in the identification of services and development of the
504 plan. If the 504 committee determines that an educational need for occupational therapy
exists, services may be provided directly to a child or as a necessary accommodation. While no
additional federal funds are available for services under Section 504 or the ADA, compliance
with the requirements are mandatory for early childhood and school settings.
Response to Intervention and Early Intervening Services
Two provisions in the 2004 reauthorization of IDEA provide additional opportunities for
occupational therapy practitioners to contribute to the success of general education students who
are struggling with learning or behavior. The first of these provisions, Early Intervening Services
(EIS), provides supports for students in kindergarten through 12th grade who are struggling with
learning or behavior. School districts can use a portion of their IDEA funds to provide
professional development for teachers and other staff and to provide direct services such as
educational and behavioral evaluations, behavioral interventions, small group instruction, and
instruction in the use of adaptive and instructional software for students who “need additional
academic and behavioral supports to succeed in the general education environment” (see
§613(f)(1)).
The second provision, Response to Intervention (RtI), is a systematic process that closely
monitors how students respond to different types of services and instruction. In the RtI process,
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The American Occupational Therapy Association
increasingly intense levels of support are provided. Decisions about which supports to provide
and at what level of intensity are made through progress monitoring and data analysis. At each
step of the process, monitoring and record keeping provide critical information about the
student’s ongoing instruction and intervention needs.
Both EIS and RtI are preventative, proactive strategies aimed at minimizing the occurrence of
behavior and learning problems as early as possible, thereby reducing the need for more
intensive services later. When these approaches are used, occupational therapy practitioners
implement strategies that can be used throughout a school. For example, suggestions might
include the use of wide-lined paper or a pencil grip to support improvements in handwriting,
modification of the classroom environment to increase accessibility, use of elastic-waist pants for
a child unable to fasten clothing after toileting, strategies to deal with a child who hits others on
the playground when he or she becomes frustrated, or general strategies for breaking down steps
for jumping rope so that a child struggling with this skill can be successful in physical education.
In addition, occupational therapy practitioners may collaborate with other professionals to design
school-wide positive mental health programs, positive behavioral support services, and anti-
bullying campaigns.
The occupational therapy role in EIS and RtI will vary from state to state and from district to
district depending on how these provisions are implemented. Because both initiatives are
targeted toward general education, school-based practitioners may need to educate student
support teams on how occupational therapy helps meet student’s learning and behavioral needs
in those environments. In addition, practitioners should participate in state and district
professional development activities related to EIS and RtI and become full participants on the
local teams considering interventions and supports students need to succeed in school (Clark,
2008; Clark & Polichino, 2008; Jackson, 2007).
OT and OTA Partnerships
Occupational therapists and occupational therapy assistants work together in early childhood and
school settings to deliver needed services. Occupational therapists are responsible for formal
evaluation and also are accountable for the safety and effectiveness of the service delivery
process, including intervention planning, implementation, outcome review, and
dismissal/discharge. The occupational therapy assistant implements the intervention plan under
the supervision of and in partnership with the therapist. State occupational therapy regulatory
agencies determine supervision frequency, methods, and documentation.
Supervision of Other Personnel
Many early intervention programs, schools, or community agencies employ paraprofessionals to
assist in the classroom or to provide direct support to some students. The occupational therapist
may utilize these individuals, as allowed by state law and regulation, to carry out selected aspects
of a service. Paraprofessionals must be properly trained and carefully supervised at all times to
assist with the provision of selected activities or programming that will enhance the student’s
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Early Intervention & Schools Statement
The American Occupational Therapy Association
ability to achieve his or her IEP goals or IFSP outcomes. Paraprofessionals do not provide skilled
occupational therapy, nor are they substitutes for the occupational therapist. Paraprofessionals
perform only those tasks that can be safely performed within the child’s routine and do not
require the expertise of an occupational therapist or occupational therapy assistant.
The tasks delegated to a paraprofessional should be documented. A plan to train and supervise
the paraprofessional must be developed by the occupational therapist. An occupational therapy
assistant may train and supervise a paraprofessional in specifically delegated tasks; however, the
occupational therapist is ultimately responsible for monitoring programs carried out by
paraprofessionals and occupational therapy assistants.
Conclusion
Occupational therapists and occupational therapy assistants provide services to children and
youth, families, caregivers, and educational staff within a variety of programs and settings. The
ultimate outcome of occupational therapy services in early childhood and school programs is to
enable the child to participate in ADLs, education, work, play, leisure, and social interactions.
References
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S26.
American Occupational Therapy Association. (2010b). Standards of practice for occupational
therapy. American Journal of Occupational Therapy, 64(Suppl.), S106–S111.
Americans with Disabilities Act of 1990, Pub. L. 101-336, 104 Stat. 327.
Americans with Disabilities Act Amendments Act of 2008, Pub. L. 110-325, 122 Stat. 3553.
Assistive Technology Act of 2004, Pub. L. 108-364, 118 Stat. 1707.
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Brannen, S. J., Cooper, E. B., Dellegrotto, J. T., Disney, S. T., Eger, D. L., Ehren, B. J, et al.
(2002). Developing educationally relevant IEPs: A technical assistance document for
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§1400 et seq.
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12
Authors
Gloria Frolek Clark, PhD, OTR/L, BCP, FAOTA
Leslie Jackson, MEd, OT, FAOTA
Jean Polichino, MS, OTR, FAOTA
for
The Commission on Practice
Janet V. DeLany, DEd, MSA, OTR/L, FAOTA, Chairperson
Adopted by the Representative Assembly Coordinating Council (RACC) for the Representative
Assembly.
Revised by the Commission on Practice 2011
This revision replaces the 2004 document Occupational Therapy Services in
Early Childhood and School-Based Settings (previously published and copyrighted in 2004 by
the American Occupational Therapy Association in the American Journal of Occupational
Therapy, 58, 681-685).
To be published and copyrighted in 2011 by the American Occupational Therapy Association in
the American Journal of Occupational Therapy, 65(6 Suppl.)
... Therapists are guided to do this by identifying students' strengths and resources to find solutions and in turn limit or remove challenges in learning. This expands on the American Occupational Therapy Association's (AOTA) guidance on SBOT practice, which emphasizes the use of expertise to enable children to prepare for and engage in significant learning and developmental activities within the school environment [2]. Therefore, SBOT is now more clearly related to enabling participation in school-based occupations overall [3,4]. ...
... For example, in Ireland, occupational therapists worked in special schools in the 20 th century, employed by nongovernment organizations primarily [25]. However, practice has since shifted to 2 Occupational Therapy International provide services to a broader range of schools, but based mainly in community clinics, funded by government health departments, which has impacted school practices also [26,27]. More recently, the Department of Education established a new initiative to pilot an in-school multitiered therapy service [28]. ...
... This is a troubling issue as SBOT has its own sources of evidence for effectiveness and good practice, which need to be considered. In the US, this challenge has been overcome as national and local guidelines to schoolbased service provision have been established [2,44]. Yet, in Ireland, other than the guidelines published by the NCSE [28] specific to their pilot project, there are no guidelines for pediatric occupational therapists working in schools, limiting the possibility of benchmarking across services. ...
Article
Full-text available
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. 1. Introduction School-based occupational therapy (SBOT) is an area of increasing international attention reflected by the first publication on this topic by the World Federation of Occupational Therapy (WFOT) in 2016. In this document, WFOT established the role of occupational therapists in school-based practice as one that is occupation-based and educationally relevant, by supporting student wellbeing, while also promoting and maximizing participation [1]. Therapists are guided to do this by identifying students’ strengths and resources to find solutions and in turn limit or remove challenges in learning. This expands on the American Occupational Therapy Association’s (AOTA) guidance on SBOT practice, which emphasizes the use of expertise to enable children to prepare for and engage in significant learning and developmental activities within the school environment [2]. Therefore, SBOT is now more clearly related to enabling participation in school-based occupations overall [3, 4]. Yet, to date, while it is apparent that occupational therapists have a role to play in schools, there is limited evidence as yet on how this occurs in relation to wellbeing and the tools and intervention approaches utilized that enable participation specifically [5]. Therefore, determining the best evidence for working in school settings is a key priority. According to WFOT, educational needs should be addressed in educational settings as an issue of best practice [1], as interventions are most effective when implemented in the natural environment (e.g., [3, 6–12]). For example, in a recent Swiss study, therapists reported that they needed to experience the natural educational environment of the school to understand the impact of the social and physical contexts on the child [13]. Using their professional reasoning, being in the school environment helped therapists to bring in an occupational perspective that complemented the educational system to accommodate the child’s needs [13]. Once in the school, the next question is what form of service delivery is most effective? In US studies, it was found that many therapists implement a pull-out approach, removing the student from the classroom to conduct one-to-one direct interventions in therapy rooms (e.g., [7, 8, 10, 14, 15]). In some cases, this is because of teachers’ expectations [7] or because therapists have more autonomy over interventions [14], while in Rodrigues and Seruya’s study (2019), therapists reported that it was more time-efficient and conducive to student schedules. There are strengths to the pull-out approach; however, many weaknesses have been identified. Christner [10] found that when therapists remove the child from the “natural context” of the classroom, it will inevitably affect their access to the curriculum covered in class which could potentially lead to academic challenges. Instead, she found that there was an improvement in therapy outcomes when performed in the natural environment. Teachers credited the improved outcomes to the presence of therapists in classroom settings which allowed for increased collaborative interventions, which teachers found less disruptive than the more traditional pull-out interventions [10]. Shifting from the pull-out model to an approach involving greater collaboration has been welcomed by therapists in principle, yet this has proven difficult for teaching professionals due to the unfamiliarity of having the therapist in the classroom [14]. Becoming familiar with each other is evidently an important consideration to maximize effectiveness of SBOT. In recent years, not surprisingly, research has examined more closely the relationship work that underpins SBOT. For example, relationship building and effective collaboration have been identified as core objectives of SBOT [10, 16, 17]. Collaboration is the ability of therapists and colleagues to mutually share expertise and respect each other’s unique skills to implement strategies to reach a goal [18]. In an Australian study, teachers identified a range of benefits to collaboration including an increase in students’ concentration and a decrease in undesired behaviours [19]. Meanwhile, therapists in Switzerland recognized building collaborative relationships with educators as a significant aspect in developing effective interventions [13]. However, there are barriers to effective collaboration such as lack of time, inability of school staff to carry over strategies, and limited understanding of occupational therapy interventions (e.g., [11, 19]). Additionally, studies have found differing expectations of the role of therapists and teachers in collaborative practices. For example, one study found that teachers believed that therapists did not perceive themselves to be in an equal working relationship [11]. In contrast, in another study, occupational therapists identified that many educators perceived the therapist’s role to be consultants, who offer solutions to “fix” a child’s challenges, and this too presents a barrier [20]. This general lack of understanding of occupational therapists as part of the team is identified as a common barrier to collaborative practice [8, 10, 11, 19]. Collaboration between these health and education professionals is a complex process that needs ongoing development to be effective [21]. Findings from the literature suggest that therapists need to spend more time in schools to build relationships and develop authentic collaborative practice, in order for their roles to be understood as equal partners rather than experts on the child. Internationally, occupational therapy services for children traditionally follow a medical model whereby the child is referred, and occupational therapy intervention is provided by the therapist. However, SBOT is beginning to shift away from this form of practice [1, 22]. Instead, other models of service delivery have been developed, such as Partnering for Change (P4C), which uses a needs-based, tiered approach to provide services to enhance occupational participation among the entire school community [17]. Missiuna et al. [17] found that a tiered service delivery model could provide individual students with diverse needs with high intensity therapy, while students at risk could receive targeted group intervention, and the entire school body could receive preventive and proactive interventions. Evaluation of the implementation of the P4C found that this model improved therapists’ confidence in delivering a school-based service and allowed for consistency in service provision [23]. Furthermore, the P4C model was effective in eliminating waitlists for occupational therapy as those who required therapy were identified and offered intervention more efficiently in their natural environment [24]. However, this new model of practice brings a challenge to SBOT as therapists have a workload which requires the provision of services to address both special and general education needs [14, 22]. It is unclear yet if tiered models like P4C are transferable to other health and education settings for SBOT delivery internationally. In regions such as North America, South Africa, and New Zealand, governments have identified the need for therapy in schools and directly employ occupational therapists to work in these contexts. However, therapists in many countries internationally are not employed to work directly in schools resulting in poorly established practices in school settings. This is a consequence of delivering therapy interventions in community-based or private practice settings, with therapists providing school-based services on an irregular basis [11]. Yet, each country has its own history and context for health and education-based occupational therapy provision that results in differing systems of service delivery. For example, in Ireland, occupational therapists worked in special schools in the 20th century, employed by nongovernment organizations primarily [25]. However, practice has since shifted to provide services to a broader range of schools, but based mainly in community clinics, funded by government health departments, which has impacted school practices also [26, 27]. More recently, the Department of Education established a new initiative to pilot an in-school multitiered therapy service [28]. The two-year pilot study began in 2018 by employing 19 speech and language therapists and 12 occupational therapists to provide therapy services for 150 schools and preschools in one region in the east of Ireland [28, 29]. Consequently, the need to establish current SBOT practice from an Irish perspective arose, as there is little research on the current state of SBOT in Ireland overall. Therefore, this research is aimed at contributing to the knowledge gap surrounding SBOT practice in Ireland by exploring the question: what is school-based occupational therapy according to pediatric occupational therapists working in schools in Ireland? The aims of the study were to describe current pediatric occupational therapy service delivery and practices in SBOT and to investigate and explore their knowledge and utilization of evidence-based practice in SBOT. 2. Materials and Methods A quantitative cross-sectional design was selected, using an online survey as this allows for larger sample sizes to be obtained, and thus, data can be gathered that represents a large population at one time [30, 31]. While there are limitations to online data collection such as sample biases and reduced control of the researchers, it is recognized that data generated can still be valid, reliable, and comparable to that of offline studies [32]. 2.1. Instrumentation Survey questions were informed by a preexisting survey designed for a SBOT study in Switzerland, which included 52 questions in total and involved a mix of open and closed questions [3]. The authors sought and were given permission to access this survey and to adapt it for use for this Irish study. The survey was critically analysed and adapted by the three coauthors to represent more directly an Irish context and to address the research question for this study. Each question was considered for the contribution it would make to describing as well as understanding SBOT practices, while deleting any that seemed repetitive or redundant. A draft of the amended survey was then sent to the European Network of Therapists in Higher Education School-Based Occupational Therapy (ENOTHE-SBOT) group. Feedback was received from this group and aided the final design of survey questions. Following good practice guidance, a pilot study of the survey was conducted with a local pediatric occupational therapist to further inform the survey development [33]. This feedback informed the final selection, list, number, and order of questions. The final survey contained 34 questions (28 closed questions and six open-ended questions), relating to three core themes: demographics (10 questions), current practice (14 questions), and education (10 questions). Closed questions included a mix of nominal (including multiple choice questions) and ordinal (Likert scales) questions. The open-ended questions related to defining practice, for example, or providing value or attitudinal responses include the following: From your perspective, how would you define school-based occupational therapy… or when working in schools, which interventions do you consider important but do not get to do? The open questions strengthened the dataset gathered by elucidating comments that could not be obtained solely using quantitative questions, allowing for answers that may not have been considered or expected [34]. As a result of this process, face validity was addressed by engaging with an expert researcher in pediatric practice who reviewed the survey instrument and confirmed that the survey measured the area of interest of the study [35]. Reliability was addressed through adapting existing survey items and conducting a pilot study, to ensure questions were interpreted appropriately in relation to the research topic [35, 36]. Ethical approval for this research study was granted by the Social Research Ethics Committee, University College Cork, Ireland, in 2018. 2.2. Participants The target population was pediatric occupational therapists who had regular experience of working in schools in Ireland. As therapists are not directly employed in schools in Ireland, the definition used for SBOT in this study was any pediatric occupational therapist working routinely in schools on an average of once a month. School-based occupational therapists were recruited through a convenience sampling method [37] through the Association of Occupational Therapists of Ireland (AOTI) database of members. AOTI emailed members to inform them of the study and invite them to take part via a link to the online SurveyMonkey platform and then recirculated the email after four weeks to maximize the response rate [33]. Potential participants were advised that consent was assumed by submission of the survey, which is common practice for online surveys [38]. To ensure confidentiality of participants, no personal identifying information was requested when completing the survey. It is estimated that 165 therapists were contacted to participate in the survey. However, neither the total population of pediatric occupational therapists nor the number of these therapists who carry out work in schools in Ireland is known. Therefore, it is only possible to estimate the response rate. In total, 49 survey responses were collected indicating an “actual response rate” of 29.7%. However, of these responses, 14 were marked as incomplete as they only answered the demographics questions (Q.1-10) and so were removed from the dataset prior to analysis. Of the remaining 35 responses, 32 participants completed the survey in its entirety, while 3 participants completed all questions related to demographics and practice but opted out of answering questions relating to training and competence and so were included to maximize the data. The outcome is that the survey generated an “analysable response rate” [33] of 21.2%. This is consistent with the typical estimated response rate of online surveys which is 20% [39]. It is important to note that as many pediatric therapists do not work in schools, this is an underestimate. 2.3. Data Analysis All 35 responses were analysed. Closed questions were analysed using descriptive statistics and presented using pie charts, bar charts, and tables [40]. Open-ended questions were analysed using qualitative thematic content analysis, which supports the researchers to identify, organize, and interpret common perspectives from respondents [41]. Peer review processes were adopted among the three coauthors to strengthen the identification and categorisation of core themes, to enhance credibility, and to maximize rigor. Relationships between qualitative and quantitative data were explored to identify points of triangulation, which served to enhance understanding. 3. Results Results are presented across the three main themes: (a) demographics, (b) description of SBOT practice in school settings, and (c) training and knowledge of SBOT. 3.1. Demographics of the Pediatric Occupational Therapists Who Participated in This Study The full details of the survey respondents’ demographics are outlined in Table 1. Survey respondents were predominantly senior grade therapists (, 71.4%), with most therapists having over six years of experience working as a pediatric therapist (, 80.0%). Geographically, Ireland is divided into four provinces. Of these, therapists working in the Munster province make up the majority of respondents (, 68.6%), while no therapists working in Connacht participated. Respondents mainly worked in settings specific to Autism Spectrum Disorder (ASD) and Developmental Coordination Disorder (DCD) (, 68.6%). Many respondents reported working in early intervention settings (, 45.7%) and services addressing physical disability (, 40.0%,), with three respondents working in child and adolescent mental health services (, 8.6%). Respondents predominantly worked with children aged five to seven years (, 45.6%). All respondents noted that they had worked in primary school settings (, 100.0%), with many also having worked in early learning and care centers (, 80.0%), postprimary schools (, 71.4%), and special schools (, 68.6%). Most respondents reported that they worked in more than 10 schools (, 71.4%), with the greatest number of respondents reporting that they work in schools monthly (, 34.3%) or weekly (, 31.4%). Respondents indicated that they work in the same school infrequently, on a needs basis (, 71.4%). Two respondents worked in the same school weekly (, 5.7%), and an additional two respondents worked in the same school biweekly (, 5.7%), while no respondents reported working in the same school daily. Characteristic () (%) Grade of therapist Senior grade 25 (71.4) Basic grade 8 (22.9) Manager 1 (2.9) Clinical specialist 1 (2.9) Length of time working as a pediatric occupational therapist 6+ years 28 (80.0) 3-5 years 6 (17.1) 1-2 years 0 (0.0) Less than a year 1 (2.9) Location of practice Munster 24 (68.6) Leinster 10 (28.6) Ulster 1 (2.9) Connacht 0 (0.0) Area of pediatric practice Early intervention 16 (45.7) Physical disability 14 (40.0) Intellectual disability 9 (25.7) Child and adolescent mental health 3 (8.6) Other (e.g., ASD and DCD) 24 (68.6) Age group of children therapists usually work with 0-4 years 9 (25.7) 5-7 years 17 (45.6) 8-10 years 7 (20.0) 11-13 years 1 (2.9) 14+ years 1 (2.9) School settings therapists have worked in Primary schools 35 (100.0) Early learning and care centers 28 (80.0) Postprimary schools 25 (71.4) Special schools 24 (68.6) Numbers of schools in therapists’ workload >10 25 (71.4) 7-9 2 (5.7) 4-6 6 (17.1) 2-3 2 (5.7) 1 0 (0.0) How often therapists work in schools, in general Monthly 12 (34.3) Weekly 11 (31.4) Biweekly 4 (11.4) Daily 0 (0.0) Needs dependent, infrequently 8 (22.9) How often therapists work in the same school Monthly 6 (17.1) Weekly 2 (5.7) Biweekly 2 (5.7) Daily 0 (0.0) Other (e.g., needs dependent and infrequently) 25 (71.4)
... School OTs work with children and youth and their parents/caregivers, educators, team members and district and agency staff to facilitate children's and youth's ability to participate in their occupations, and activities of daily living that are purposeful and meaningful to the person (Clark, Polichino, & Jackson, 2011) and to adapt to new occupations and this new situation during the pandemic COVID-19. They focus on a wide range of occupational performance areas (education, social participation, play, leisure, work, activities of daily living), and provide services in schools, at home and in early intervention settings as the primary work environments for occupational therapists (Jackson, 2007). ...
... OT services are provided for habilitation, rehabilitation and promotion of health and wellness for children with disability and non-disability related needs. These services include acquisition and preservation of occupational identity for those who have or are at risk for developing an illness, disease, disorder, condition, impairment, disability, activity, limitation or participation restriction (Clark, Polichino, & Jackson, 2011). ...
... The scope of occupational therapy evaluation and intervention in the school setting includes areas that affect the child's learning and participation in the context of educational activities, routines, and environments (Clark, Polichino, & Jackson, 2011). Illness or developmental challenges can impact students' ability to participate in occupations, so school OTs work with children to explore whether making a change to the person, the occupation or the environment might enable occupational participation, and the same applies to training in new occupations and routines related with COVID-19. ...
Article
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School-based occupational therapy (OT) is very important because it helps the student to be more successful and engage or participate in roles, habits, routines and occupations at school, and those related to the COVID-19 pandemic. The COVID-19 pandemic brought huge changes to the daily lives of people worldwide and affected their participation in almost all their daily activities or occupations. Occupation includes all purposeful human activity through which people can influence their health and well-being and adapt to change. Measures related to COVID-19 and lockdown (when there is one) require changes in the daily school and home routine of students who need new training (especially those in special schools) to protect their health and adapt to changes. School occupational therapists (OTs) work with teachers and the school team and have an important role among the interdisciplinary team in occupational engagement, in order to avoid the negative consequences of illness and disability and promote the positive impact of participating in occupations on a student's health and well-being. They focus on a wide range of areas of occupational performance such as education, social participation, play, leisure, work and activities of daily living. The purpose of this short report is to highlight the usefulness of school-based OT in supporting students in everyday life, including new COVID-19 conditions. Some directions are also discussed, so as for OTs, teachers and school team to be able to help students meet the challenges during the COVID-19 pandemic in OT school-based services including self-care, hygiene, masks and facial coverings , daily school and home routine, social distancing, e-learning/technology management and telehealth in collaboration with parents, and other professionals in school.
... The participants indicated that social or emotional demands are a large factor that influences functioning at the middle school level. However, social and emotional (Clark, Jackson, & Polichino, 2011;Spencer, Turkett, Vaughan, & Koenig, 2006), there is a paucity of research exploring interventions in middle schools (Andrew, Penny, Simpson, Funnell, & Mulligan, 2004;Eccles, Barber, Stone, & Hunt, 2003;Humphrey, 2002). ...
... An important area of development in middle school settings is those needs related to mental health and psychosocial function- including the School Mental Health Tool Kit, available on the AOTA website. There are also resources that identify best practice interventions as those provided within the natural school environment, while the student engages in the specific tasks and activities with which he or she requires assistance (Clark et al., 2011;Frolek Clark & Chandler, 2013;Handley-More et al., 2013). Additional best practice models include collaborating with parents, educators, and other team members to effectively promote carryover and encourage academic success, and addressing mental health issues, such as positive behavioral support measures. ...
... However, social and emotional Labor, 2012). Although a significant number of studies have explored occupational therapy interven- tions in elementary schools (Clark, Jackson, & Polichino, 2011;Spencer, Turkett, Vaughan, & Koenig, 2006), there is a paucity of research exploring interventions in middle schools (Andrew, Penny, Simpson, Funnell, & Mulligan, 2004;Eccles, Barber, Stone, & Hunt, 2003;Humphrey, 2002). ...
... including the School Mental Health Tool Kit, available on the AOTA website. There are also resources that identify best practice inter- ventions as those provided within the natural school environment, while the student engages in the specific tasks and activities with which he or she requires assistance (Clark et al., 2011;Frolek Clark & Chandler, 2013;Handley-More et al., 2013). Additional best prac- tice models include collaborating with parents, educators, and other team members to effectively promote carryover and encour- age academic success, and addressing mental health issues, such as positive behavioral support measures. ...
... Occupational therapists can play a collaborative role in enabling the occupation of education for children in the ECD environment 63,64 . The activities in which children participate should be step-by-step, analysed, age-appropriate and culturally relevant, and stimulate the child holistically (all domains of development) 65 . Play is the main occupation of a child, therefore all activities in an ECD programme should involve learning through play to ensure that all developmental and learning outcomes are achieved 65 . ...
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Background: The occupation of education prepares children for adulthood. Each child has the right to education, which has the power to end intergenerational cycles of poverty and inequality. However, poor access to and quality of education at early childhood development (ECD) centres continue to prevail in marginalised communities in South Africa. Aim: This study aimed to identify the challenges experienced by ECD practitioners and coordinators regarding the quality of their ECD programme. Methods: A qualitative, descriptive enquiry was conducted with six purposively sampled participants from an ECD organisation in South Africa. Semi-structured interviews were conducted with practitioners from under-resourced ECD centres from Bloemfontein, rural towns, and the organisation’s ECD coordinator. Audio recordings of the interviews were transcribed verbatim. Deductive content analysis was used to analyse the data. Results: Four themes were identified from interview data: (i) teaching and learning; (ii) management and leadership; (iii) ECD environment; and (iv) ECD legislation and policies. Practitioners indicated that they wanted to improve their qualifications and have access to a contextually relevant programme with appropriate resources. Conclusion: If the expressed challenges were addressed on an inter-professional collaborative platform, the quality of this ECD service could be improved.
... Occupational therapists can play a collaborative role in enabling the occupation of education for children in the ECD environment 63,64 . The activities in which children participate should be step-by-step, analysed, age-appropriate and culturally relevant, and stimulate the child holistically (all domains of development) 65 . Play is the main occupation of a child, therefore all activities in an ECD programme should involve learning through play to ensure that all developmental and learning outcomes are achieved 65 . ...
Article
BACKGROUND: The occupation of education prepares children for adulthood. Each child has the right to education, which has the power to end intergenerational cycles of poverty and inequality. However, poor access to and quality of education at early childhood development (ECD) centres continue to prevail in marginalised communities in South Africa AIM: This study aimed to identify the challenges experienced by ECD practitioners and coordinators regarding the quality of their ECD programme METHODS: A qualitative, descriptive enquiry was conducted with six purposively sampled participants from an ECD organisation in South Africa. Semi-structured interviews were conducted with practitioners from under-resourced ECD centres from Bloemfontein, rural towns, and the organisation's ECD coordinator. Audio recordings of the interviews were transcribed verbatim. Deductive content analysis was used to analyse the data RESULTS: Four themes were identified from interview data: (i) teaching and learning; (ii) management and leadership; (iii) ECD environment; and (iv) ECD legislation and policies. Practitioners indicated that they wanted to improve their qualifications and have access to a contextually relevant programme with appropriate resources CONCLUSION: If the expressed challenges were addressed on an inter-professional collaborative platform, the quality of this ECD service could be improved Keywords: Teaching and learning; early childhood development; ECD policy and legislation; ECD practitioners; ECD programme; occupational therapy; South Africa.
... OT in the school setting supports students in health and participation through engagement in occupations, such as accessing daily school activities and providing services to assist students in managing, organizing and performing tasks (Clark, Jackson, Polichino, & DeLany, 2011). ...
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Background/aim: Individuals, between the ages of 3-21, may receive occupational therapy (OT) and/or assistive technology (AT) services during the course of their academic life to assist in providing access to a free and appropriate public education (FAPE). Within the school-based setting, occupational therapy and assistive technology services are rendered to students to assist in improving, increasing, or maintaining independence with accessing, participating, or performing a task that encompasses academic achievement and functional performance. Using a phenomenological design, this study explored the processes of implementation and integration of assistive technology and the role of occupational therapy imparts within a public-school setting. The significance of this study will assist occupational therapy practitioners, educators, and assistive technology professionals in not only recognizing the barriers and potential roles within a school setting but may aid in establishing an effective and efficient assistive technology process. Methods: Participants consisted of seven occupational therapists and one occupational therapist assistant (n=8) who have a minimum of at least three years experience working in the school setting. Semi-structured interviews were performed to provide perspective from occupational therapists followed by a triangulation method to extract and validate themes. Findings: Overall, four themes were extracted: (1) Views on the assistive technology process, (2) Views on OT’s role in assistive technology delivery, (3) View on barriers associated with successful AT delivery, (4) Perspectives on elements that would improve the assistive technology process. Conclusion: The themes illuminated three considerations: Although OTs and some ATP are employed in school districts, there is not an established or defined AT process in place; OT practitioners have expertise in meeting task analysis and environmental modification needs, but there is not an established role or consistent utilization process of this expertise, barriers to successful implementation and integration appear to be a direct result of no effective role delineation.
... In addition to research utilizing Head Start populations, the role of occupational therapy in Head Start and early intervention services is well documented. To support the evidence-based practice of occupational therapy in early childhood, systematic reviews of the effectiveness of multiple intervention strategies were completed in 2013 (Arbesman, Lieberman, & Berlanstein, 2013;Case-Smith, 2013a, 2013bCase-Smith, Frolek Clark, & Schlabach, 2013;Clark, Jackson, & Polichino, 2011;Howe & Wang, 2013;Kreider et al., 2014). In this same year, practice guidelines for occupational therapy in early childhood were published (Clark & Kingsley, 2013). ...
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This preliminary, descriptive study yields information on the utilization of occupational therapy services within Head Start programs. Participants completed an Internet-based survey of 25 questions pertaining to the understanding, scope, and utilization of occupational therapy services. Surveys were completed by 35 respondents nationwide. A total of 55.17% of respondents indicated occupational therapy services are available in their Head Start programs, yet 78.57% of respondents indicated the Head Start teacher addressed concerns related to occupational therapy practice areas. This preliminary data indicates that occupational therapy services are understood and available but not fully utilized in Head Start programs.
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Background/aim: Children are reported to spend less time engaged in outdoor activity and object-related play than in the past. The increased use and mobility of technology, and the ease of use of tablet devices are some of the factors that have contributed to these changes. Concern has been raised that the use of such screen and surface devices in very young children is reducing their fine motor skill development. We examined the effectiveness of iPad applications that required specific motor skills designed to improve fine motor skills. Method: We conducted a two-group non-randomised controlled trial with two pre-primary classrooms (53 children; 5-6 years) in an Australian co-educational school, using a pre- and post-test design. The effectiveness of 30 minutes daily use of specific iPad applications for 9 weeks was compared with a control class. Children completed the Beery Developmental Test of Visual Motor Integration (VMI) and observation checklist, the Shore Handwriting Screen, and self-care items from the Hawaii Early Learning Profile. Results: On post testing, the experimental group made a statistically and clinically significant improvement on the VMI motor coordination standard scores with a moderate clinical effect size (P < 0.001; d = 0.67). Children's occupational performance in daily tasks also improved. Conclusion: Preliminary evidence was gained for using the iPad, with these motor skill-specific applications as an intervention in occupational therapy practice and as part of at home or school play.
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This document provides information, based on the final Part B regulations implementing statutory changes made by the Individuals with Disabilities Education Act (IDEA) of 1997, which will assist speech-language pathologists in their role in developing Individualized Education Programs (IEPs) as IEP team members and in implementing those portions of the IEP for which they are responsible. Included are issues regarding programmatic and systemic changes that must take place in order for successful partnerships to be established among speech-language pathologists, teachers, parents, audiologists, and other related service providers. Following an introduction, Section 2 provides some background information on IDEA and educationally-relevant IEPs. Section 3 discusses guidelines for developing educationally-relevant IEPs and addresses the following issues: (1) collaboration and teamwork; (2) the role of the speech-language pathologist; (3) essential components of the IEP; and (4) selected aspects of the educational process relevant for speech-language pathologists. Section 4 emphasizes the importance of regular education teacher involvement, staff development, collaboration skills, time, and support for school personnel in integrating IEPs with the general curriculum. Appendices provide a comprehensive guide to the requirements for IEPs based on the federal legislation and regulations and sample IEPs. (Contains 14 references.) (CR)
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Give your students access to the general curriculum and find better ways to assess their progress! How is your special-education curriculum impacted by the requirements of IDEA and NCLB? How can you improve student learning and retention to positively influence assessment results? What methods are available for determining your students' present level of performance? In this second edition of the best-selling Accessing the General Curriculum, Nolet and McLaughlin provide updated frameworks and strategies-with invaluable examples and flowcharts for fitting special education into the frameworks created by national standards and assessments. This invaluable resource provides K-12 educators with the support necessary to produce expected results from every learner. The authors begin with far-reaching legal implications and connect them with individual students to show teachers how to: Use curriculum as a map for guiding students toward achievement; Understand learning research as a bridge to the learning-teaching connection; Relate each student's disability to his or her academic performance; Design alternate assessment tools and curriculum; Link goals, objectives, and benchmarks to state assessment criteria Affording special education students accommodations and modifications to their individual curriculum will improve their performance, enhance your ability to help them advance, and, ultimately, improve the evaluation of their progress throughout their academic career.
FAQ on response to intervention for school-based occupational therapists and occupational therapy assistants
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