Our study describes the environmental factors, body functions, and activities and participation, addressed by occupational therapists (OT) and occupational therapy assistants (OTA) in the Partnering for Change (P4C) tiered school-based service delivery model in Ontario, Canada. Thirteen OTs and 10 OTAs in nine schools collected data using service logs organized by categories of occupations. Subsequently, service logs were de-identified, and the data mapped to domains of the International Classification of Functioning, Disability and Health. A beta-binomial model was used to assess the probability that specific environmental factors (e.g. classroom layout), body functions (e.g. self-regulation), and activities and participation (e.g. self-care and productivity-related tasks) were addressed at each service tier (e.g. Tier 1 Universal, Tier 2 Targeted, and Tier 3 Individualized) and by each professional (OT vs. OTA). We employed a Bayesian hierarchical approach to control for individual differences. Results indicated that activities related to productivity, such as handwriting and printing, had the highest probability of being addressed across tiers. Activities related to self-care and leisure were addressed at lower probabilities (<10%) across tiers. Environmental factors were addressed at all tiers, but most notably at Tier 3. OTs addressed a broader range of environmental factors, body functions, and activities and participation compared to OTAs, with significant differences across all tiers. Future research could explore the decision-making processes that influence which environmental factors, body functions, and activities and participation are addressed in P4C, and the nature of OT and OTA collaboration in this service model.
Successful transition to adult life is a primary goal of special education and critically important for students with Intellectual and Developmental Disabilities (IDD) who lag behind their typical peers in achieving adult outcomes. Education systems are highly invested in supporting student success after graduation and proactively address postsecondary readiness. Occupational therapy practitioners, with their focus on engaging in occupations to support participation in life and their distinct knowledge and skills related to engaging in occupations, can provide a range of Tier 1 interventions that focus on supporting postsecondary outcomes. This article discusses best practices for supporting transitions and identifies Tier 1 strategies that occupational therapy practitioners can implement to address predictors of postsecondary success for students with IDD to the benefit of all students.
A community-centered, occupation-based program was implemented among children and families in the Bronx to enhance reading engagement, children's perceptions of reading, and caregiver confidence in supporting literacy routines. Strong evidence shows that parent - child shared reading improves children's reading participation and early literacy development. Moderate evidence also supports occupation- and activity-based literacy interventions for improving children's reading attitudes and participation. Based on this evidence, the reading program fostered an environment that engaged both peers and parents in meaningful reading-based group activities. A single-group pretest - posttest design was used to measure change, with six children and four caregivers completing pre/post surveys. Caregiver surveys included a ten-item, five-point Likert-type scale and qualitative questions about home routines. Child surveys used a ten-item, three-point Likert-type scale assessing reading self-perception, reading habits, and reading strategy use. Caregivers demonstrated high baseline attitudes toward reading, yet improvements were observed in knowledge of reading strategies and beliefs about the social value of literacy. Children showed increased enjoyment of reading, particularly endorsing that reading is fun (from 67% to 100% "Yes"), along with gains in reading aloud and functional reading. Several items remained stable, and minor decreases in a few child items likely reflected normal variability. These findings support occupation-based, community-delivered literacy programs in underserved settings. Embedding reading into play, routines, and meaningful activities may help occupational therapists promote literacy through motivation and participation. Research using larger samples and longer program duration is needed.
The assessment of developmental milestones in children with developmental disabilities often reveals discrepancies between parents' and professionals' evaluations. Understanding these differences is crucial to enhancing early intervention strategies, especially in domains such as problem-solving and communication. The hypothesis of the present study is that there is a significant difference between parents' and professionals' perceptions of developmental milestones, which suggests that assessment tools may yield different information depending on who completes the evaluation. The main objective of the study is to define the extent of discrepancies between families and professionals regarding the development of children with developmental disabilities. An observational, cross-sectional study was conducted on 54 children receiving early intervention services. Parents and professionals independently assessed the children's developmental milestones using the ASQ-3 tool. Descriptive and inferential statistical analyses, including Wilcoxon tests and Spearman's correlation, were performed to explore discrepancies in these evaluations. Parents consistently provided more positive evaluations of their children's development than professionals. The largest discrepancies were found in the problem-solving (mean difference: 5.19 points, p = 0.019) and communication subscales (mean difference: 4.07 points, p = 0.052). Cohen's Kappa revealed moderate agreement in most areas, except for fine motor skills, which showed fair agreement (Kappa = 0.386). Parents tend to report higher levels of their children's developmental progress compared to professionals. The largest discrepancies were observed in problem-solving and communication. These findings highlight the need for better communication and collaboration between parents and professionals to ensure more accurate assessments.
Occupational therapists (OTs) provide invaluable strategies to enhance the learning of children with disabilities within pre-school settings. Literature highlights a lack of communication and collaboration between OTs and classroom staff in such settings, resulting in poor carryover of OT strategies in classrooms. The purpose of this study was to assess the effectiveness of a theory-driven, multimedia education module focused on changing classroom staff's knowledge and confidence toward OT strategies. Development of the intervention was guided by Guskey's Model of Teacher Change in implementing specific strategies commonly used within this setting. A pre- and posttest design was employed using a questionnaire that was developed following Guskey's model to determine the likelihood of classroom changes among the 31 classroom staff members surveyed. The educational module positively impacted the knowledge and confidence of the participants, with the greatest change noted for the sensory diet strategy, while the educational level of the participants did not impact changes. Enhancing knowledge and confidence in OT strategies among classroom staff using a theory-driven intervention demonstrates preliminary support for changing classroom behavior among teaching staff for such strategies. This study sets the groundwork for translating OT strategies to the classroom, as well as future research in this area.
Neurotypically developing learners are increasingly being referred to occupational therapists without a diagnosis, but where the main concern is sensory processing disruptions and/or maladaptive behaviors that negatively influence the child's educational progress. The purpose of the study was to describe the sensory processing and behavior of neurotypically developing learners aged 6 to 10 years within in the foundation phase in the South African mainstream classroom environment. A quantitative, descriptive cross-sectional design was used with 138 neurotypically developing learners. Parents completed a demographic questionnaire, and teachers completed the Sensory Processing Measure and Conners Teacher Rating Scale-3. Data were analyzed descriptively and using inferential analysis. Most learners were found to have typical sensory processing and behavioral profiles. Between 9%- 30% of learners had atypical profiles and were considered at-risk. A third of learners met the criteria for atypical Defiance/Aggression, Learning Problems, and Attention-Deficit/Hyperactivity Disorder, and almost half of these were found to have atypical anxiety or depressive behaviors. Significant differences were found in classroom behavior and sensory profiles for gender and repeating a grade. The percentage of neurotypically developing learners who present atypical sensory and behavioral profiles and face barriers to learning could benefit from occupational therapy.
This scoping review aimed to explore the existing peer-reviewed literature on occupational participation and the experiences of children within mainstream primary education in the United Kingdom (UK). The focus on the UK was chosen to inform context-specific educational and therapeutic practices. The review sought to identify key themes and gaps in the British body of literature, following established methodological frameworks. Three researchers jointly searched multiple electronic databases (SCOPUS, EBSCO [CINAHL/Medline], PsycINFO, ERIC, British Education Index, Child Development and Adolescent Studies, OTseeker, ProQuest Dissertations & Theses and The British Library,) using a comprehensive set of search terms (see Table 1). Inclusion criteria were: peer-reviewed articles published in English between 2013 and 2023, focusing on the participation of UK-based, primary-aged children (4-11 years) in mainstream education. Thematic analysis was conducted to identify patterns across the literature. From an initial yield of 230 articles, 13 met the inclusion criteria. Although none directly addressed occupational participation, five key themes emerged: (1) meaningful relationships with school staff, (2) meaningful relationships with peers, (3) structural influences on participation, (4) children as learners, and (5) agency and choice. These themes were interpreted through the lenses of resilience theory, critical pedagogy, and the Canadian Model of Occupational Participation (CanMOP). This review highlights a significant gap in the UK literature concerning children's occupational participation in mainstream primary education. While the findings offer insights for UK-based educators and healthcare professionals, the national focus limits generalizability. Future research should explore children's occupational participation more directly and consider comparative international perspectives to inform broader educational and occupational therapy practices.Table 1.Search terms.Main term Additional terms - and/or Additional term - and/or Databases Child*Paed*primaryschooleducationinfantJuniorPupilStudentLived experienceOccupationWell-beingActivitySCOPUSEBSCO (Cinahl/Medline)PsycINFOERICBritish Education IndexChild Development and Adolescent StudiesOTseekerBritish LibraryProQuest Dissertations & Theses
Food selectivity is a common and challenging issue among children with autism spectrum disorder (ASD), often leading to nutritional deficiencies and difficulties participating in communal mealtimes such as Japan's standardized school lunch (ky & umacr;shoku). This single-case study examined the effectiveness of a consultation-based occupational therapy (OT) intervention to improve food acceptance in a school setting. It involved a 7-year-old nonverbal boy with ASD and intellectual disability who was attending a special needs school in Japan. Over four months, occupational therapists provided consultation to the classroom teacher using baseline assessments, observations, and collaborative planning. Intervention strategies included the use of familiar dishware, pairing new foods with preferred items (bread), donburi-style mixed rice presentation, and a low-pressure, supportive approach. Changes in food acceptance and mealtime behavior were measured using the Autism Spectrum Disorder Mealtime Behavior Questionnaire and a food checklist, completed pre- and post-intervention. The number of school lunch items accepted by the child increased from 4 to 24, and the Food Selectivity score decreased from 4.0 to 2.4. Qualitative teacher reports indicated reduced anxiety, improved participation, and heightened curiosity during mealtimes. OT-informed, teacher-led, trust-based, low-pressure and culturally adapted interventions, can significantly improve food variety and mealtime behavior in children with ASD, especially in communal eating settings.
At-risk youth are more susceptible to engaging in high-risk behaviors that may hinder their successful transition into adulthood. Despite serving a high proportion of at-risk youth, many after-school program (ASP) staff receive little to no training in trauma, trauma-informed care (TIC), or their role in supporting positive youth outcomes. This project sought to answer the question, "Does trauma-informed care (TIC) education improve after-school program staff's self-efficacy to support positive youth development and foster protective factors in the at-risk youth they serve?" Twelve ASP staff participated in a 6-week, in-person educational program consisting of weekly 60-minute sessions. Pre- and post-intervention surveys assessed participants' knowledge of TIC principles, perceived self-efficacy, and ability to implement TIC strategies. Quantitative data indicated increased knowledge of trauma and trauma-informed care techniques, greater understanding of staff's role in youth development, and improved confidence in supporting at-risk youth. Qualitative data further reflected staff understanding and application of TIC strategies and overall satisfaction with the training. This demonstrates the positive impact of TIC education on staffs' self-efficacy and the potential to enhance protective factors among at-risk youth in after-school settings. It also highlights the valuable role of occupational therapy in promoting trauma-informed practices and youth resilience within ASP.
The occupational profile is foundational to the occupational therapy evaluation process, however, its actual integration in school-based occupational therapy evaluations is unknown. The objective of this study was to determine how many school-based occupational therapists complete an occupational profile and how they integrate this in evaluations. A mixed-methods design was used via an anonymous survey with 10 closed-ended (quantitative) and 5 open-ended (qualitative) questions. Data were collected over a 5-week period. A total of 178 school-based occupational therapists were recruited through purposive sampling via social media and e-mail. Quantitative analysis included descriptive and associational statistics. Qualitative analysis utilized a phenomenological approach. Trustworthiness was established via audit trials, peer review, reflexivity, and rich descriptions. In total, 65.2% of the participants included an occupational profile in their school-based evaluation but only 59.6% thought the occupational profile is required and only 17.4% include the wording "occupational profile" on the evaluation report. Three themes emerged on how the occupational profile is integrated: I don't; I do but not formally; I do. Conclusively, despite the requirement in the occupational therapy practice framework, school-based occupational therapists do not always include the occupational profile during their evaluations, necessitating a reminder and education to promote best practice.
This descriptive case series explored preschool staff perceptions of classroom-based sensory corners developed using occupational therapy principles. Sensory corners were introduced as a proactive, child-directed environmental strategy to support emotional regulation and participation in two preschool classrooms. The five-week implementation phase was embedded within daily routines, and a mixed-methods approach examined feasibility, acceptability, and staff-perceived impact.Four preschool staff participants completed pre-intervention behavior rating scales of observed student behaviors. Three of the four completed post-intervention behavior rating scales, and all four completed a post-intervention survey assessing implementation outcomes. Quantitative findings suggested reductions in the frequency of staff-reported observable classroom behaviors related to regulation and participation among most participants with complete data. Qualitative responses highlighted perceived benefits (e.g. visual aids, breathing tools) and barriers (e.g. limited space, staffing constraints, inconsistent use), aligning with five themes: accessibility, barriers to use, beneficial aspects, perceptions of the push-in coaching model, and general feedback.Results provide context-specific insight into how sensory-informed strategies can be embedded in early learning environments and underscore the importance of interprofessional collaboration in supporting educator-led implementation within Tier 1 classroom supports in multi-tiered systems of supports (MTSS).
Carrying heavy school bags is a common cause of musculoskeletal discomfort in primary school students, often leading to postural deviations and pain. Despite growing awareness, there is limited evidence on child-friendly interventions that address this concern. This study examined the effectiveness of a play-based postural training programme in reducing musculoskeletal discomfort due to school bag loads among primary school children. A quantitative true-experimental design was used with 30 students (aged 5-10 years) from Queen Mary's Primary School, Ranipet district. Participants were randomly allocated into an experimental group (n = 15) receiving a structured play-based postural training programme for 36 sessions, and a control group (n = 15) receiving exercise-based control intervention for the same duration. Musculoskeletal discomfort was screened using the Nordic Musculoskeletal Questionnaire and outcomes were assessed through pre- and post-intervention with Borg's Rating of Perceived Exertion (RPE) scale. Data were analyzed using paired t and independent t tests. The experimental group showed a highly significant reduction in musculoskeletal discomfort scores from pretest (M = 6.73, SD = 0.96) to posttest (M = 2.47, SD = 0.91, p < 0.001). Posttest comparison revealed greater improvement in the experimental group compared to the control group (p < 0.001). Results demonstrated that the play-based postural training programme was associated with significantly greater reductions in musculoskeletal discomfort compared to exercise-based control intervention. These findings support the use of playful, developmentally appropriate interventions in promoting postural health in children.
For autistic students who menstruate, managing menstrual hygiene may be an important part of their daily school routine. Special educators may be able to contribute their perspectives on menstruation and menstrual hygiene management (MHM) based on their firsthand experiences in working with autistic students in the classroom. This qualitative study used a phenomenological approach to examine the lived experiences of special educators in supporting autistic students with menstruation and menstrual hygiene management. Semi-structured interviews were conducted over Zoom with special educators who work with autistic students in fourth grade and above. Data analysis was performed utilizing Dedoose and included interview transcription, coding, and development of themes. Five special educators with over 65 combined years of experience working in special education with autistic students were recruited through convenience and snowball sampling. Five themes emerged from the interviews: disproportionate numbers in the classroom; resources and training for special educators on autism and menstruation; changes in presentation of autistic students during their menstrual cycle; the taboo nature of menstruation; and strategies in the special education classroom. The lived experiences of special educators explicated from the interviews provide key components for occupational therapy practitioners to consider about menstruation and MHM when working with autistic students in the school setting. The study provides insight into an underrepresented area and paves the way for future studies on menstruation and menstrual hygiene management for autistic individuals.
Odia, one of India's 22 official languages, is primarily spoken in Odisha, where it functions as the primary medium of instruction up to the senior secondary level. As the first language of children in this region, Odia handwriting holds strong cultural and educational significance, particularly in literacy development. Despite this importance, research on early handwriting education and assessment in Odia remains limited. This study examines typographic factors influencing the legibility of Odia handwriting among children aged 5-7 years. Sixty-two participants (Mage = 5.89, SD = 0.61) participated in systematic writing tasks based on listening and copying. Expert evaluators fluent in Odia assessed the handwritten samples for letter shape reproducibility and overall legibility. Qualitative analysis of evaluator comments, employing coding and thematic categorization, revealed key determinants of legibility, including stroke operations, inter-component relations, and functional letter-part attributes. The study concludes with suggestions for refined and systematic assessment methods based on typographic factors to inform Odia handwriting pedagogical practices and the management of handwriting-related learning challenges.
Movement plays a significant role in a student's school day. Evidence-based research demonstrates improved cognitive, behavioral, psychosocial and physical skills. Barriers exist, however, and students are not getting enough physical activity. Occupational therapy providers can support school-based movement integration in a variety of ways. The purpose of this study was to determine how movement is used during the school day, teachers' perceptions of movement integration, and the effectiveness of providing resources and teacher training to improve occupational movement integration. Based on identified barriers and facilitators in the literature, and the Health Belief Model theoretical framework, a questionnaire was developed and administered to teachers before and after the intervention. Findings indicated statistically significant pre- to post-survey results for increased integration of movement in academic content and teachers' feelings that they had access to helpful materials, classroom space, time in the day and adequate training for movement integration. Movement activity resources and training were effective strategies and made a positive difference as a school-wide, occupation-based health promotion initiative.
This study explored children's and school staff perceptions of the implementation process, recess participation, and the attributes of Loose Parts Play (LPP). A 15-month explanatory single-case study design was employed involving a rural inclusive school. Multi-component implementation strategies were utilized over an entire school year to support the tailored adoption of LPP. Focus groups (6 school staff/parents; 9 children, grades 3-7 with/without disabilities) and individual interviews (principal) were conducted at two time points, 7 months apart. Thematic analysis was conducted. Common themes across two time-points suggested a shift in perception supporting the implementation process among school staff: Participation and Engagement, Duty of Care and Risk, and Filling a Void, and among children: Keep Us Safe and Let us Play, and Recess Vibe. Unique themes surrounding implementation identified by adults, Planning the "How to" and What We've Learnt from this Process, and by children, LPP Would be Cool and We Have Ideas to Make it Better, contributed to tailoring LPP in their context. Completed the next school year, follow-up surveys (7 school staff) suggested the experience remained positive, and LPP continued. School-based occupational therapists can build on this knowledge when seeking to implement and sustain LPP, fostering participation at recess.
Children from low socioeconomic backgrounds are at higher risk for developmental delays due to multiple contributing factors. In Iowa, 12.5% of children live in poverty, increasing this risk. Despite the known benefits of early intervention (EI), many children do not receive timely developmental screenings, leading to missed opportunities. This study evaluated the feasibility of implementing occupational therapy (OT) developmental screenings in Iowa's Head Start program. Participants included 30 children, ages 3-5, attending Head Start preschool in central Iowa. Researchers administered the Developmental Assessment of Young Children Second Edition (DAYC-2) and compared results with the GOLD observational assessment completed by Head Start staff. Additional data, including field notes and child satisfaction ratings, were collected using mixed methods to assess feasibility. Results indicated that conducting OT screenings in Head Start is feasible, with recommendations for improved methods. Findings also revealed minimal correlation between DAYC-2 and GOLD scores. These results highlight the role of OT in early detection of developmental delays and the value of their involvement in screening. By demonstrating both feasibility and effectiveness of OT-based screenings, this study could lead to broader implementation of such programs, thus improving developmental outcomes and quality of life.
Traditional perspectives on school readiness have emphasized child-level competencies such as cognitive, language, and behavioral skills. While important, the narrow focus overlooks the ecological systems - families, teachers, and communities - that shape children's adaptation to school. The participation-oriented perspective of occupational therapy has also been largely absent from the discourse. The School Readiness Ecological Approach (SERA) reframes school readiness as a matter of ecological fit rather than merely a set of children's skills. Based on Bronfenbrenner's ecological systems theory and the Person - Environment - Occupation model, SERA conceptualizes readiness as the outcome of dynamic exchanges between children, families, educators, schools, and policy environments. SERA addresses key gaps by: (1) shifting focus from isolated child attributes to participation in real-life contexts; (2) integrating occupational therapy's holistic perspective into readiness; and (3) providing a multi-level framework to guide research, practice, and policy. SERA emphasizes four domains - child, family, educational environment, and community - as interconnected contributors to school readiness trajectories. As a conceptual bridge across education, health, and social systems, SERA will broaden theoretical scope, foster interdisciplinary collaboration, and promote inclusive, and sustainable strategies. Reconceptualizing school readiness as ecological fit will help move beyond deficit-based views and support more equitable and effective school transitions.
This study investigated the impact of the COVID-19 pandemic on the prewriting and handwriting skills of young children by evaluating worksheet samples collected in the fall semester of 2021 to assess potential changes and challenges that arose early in 2020 through 2021. This study does not provide a comparative analysis of pre- and post-COVID results, given the unavailability of worksheet samples prior to the COVID-19 pandemic. Rather, this study focused on discerning changes in foundational literacy skills that are critical for early educational development amid widespread educational disruptions and the abrupt shift to remote learning. The methodology involved qualitative analysis of handwriting samples from children aged three to nine, focusing on hand dominance and grasp, far- and near-point copying (specifically, legibility, size, directionality, placement, speed, and visual-motor integration), bilateral hand skills, and in-hand manipulation. The results indicate regression in handwriting proficiency across two age groups (3 to 5 years and 6 to 9 years), with younger children struggling significantly with visuospatial organization and fine motor skills and older children facing difficulties in maintaining consistent placement and speed. The findings highlight young children's deficits in handwriting development post-pandemic and underscore the need for targeted instructional strategies to remediate these skills. Enhanced educational interventions and further research to explore long-term impacts and recovery strategies are needed.
