Supporting inclusive education through interprofessional collaboration requires developing capacity among school professionals. Partnering for Change (P4C) fosters inclusive-learning environments through teacher-occupational therapist (OT) partnerships, but its capacity development process is underexplored outside of Canada. To explore capacity development to create inclusive learning environments among teachers and OTs during interprofessional collaboration within P4C in Sweden. An embedded mixed-methods design was used in this small exploratory study. Ten P4C-teachers and five OTs, along with eight control teachers, completed questionnaires on knowledge, beliefs, and skills for inclusion, analysed using descriptive statistics, Friedman's ANOVA, and parallel coordinates plots. Three focus groups with P4C-professionals were analysed to identify categories related to capacity development and collaboration. Self-reported inclusion-related knowledge, beliefs, and skills increased over time among participants, with larger changes among P4C-teachers compared to controls. P4C-professionals' experiences of capacity development included greater awareness of pupil diversity, class-wide adaptations, and differentiated teaching. Classroom-based collaboration supported shared learning and solution development. Key aspects of collaboration included valuing roles, open communication and shared goals. Findings suggest P4C supports capacity development for inclusion through interprofessional collaboration. Further research with larger samples is needed to confirm these results.

Efforts to advance inclusive education have gained increasing attention in Sweden and the Netherlands. Effective cross-sector collaboration among diverse stakeholders is essential to ensure that all children's needs are adequately met. However, existing service delivery models remain largely referral-based, focusing on the individual needs of a child. There is a growing need for system-wide, context-based approaches that enable inclusion and belonging of all children. One such model is Partnering for Change (P4C), developed in Canada. Implementing P4C in new contexts requires careful consideration of cultural and systemic differences. This paper describes the process of adapting the P4C model for the Dutch and Swedish educational contexts, guided by a four-phase framework and a multiphase mixed-methods approach. It presents the adapted P4C model and shares key lessons, offering insights into effectively embedding inclusion-related service delivery in education.

Objectives: Hearing loss is among the most common chronic conditions worldwide, substantially affecting daily life. Its management typically involves person-centered rehabilitation focusing on hearing aid fitting and active client participation. The Empowerment Audiology Questionnaire (EmpAQ) is a self-report instrument assessing empowerment, available in 15-and five-item versions. The EmpAQ was recently translated into Swedish (EmpAQ SWE), with satisfactory content validity, convergent validity, and reliability. This study aimed to further evaluate the EmpAQ SWE by examining its construct validity. Design: Adults with hearing loss (pure-tone average > 20 dB HL in the better ear) were invited to complete a digital survey (n = 1,176); 152 participants responded. The survey included demographic questions and both EmpAQ-15 and EmpAQ-5. Rasch analysis was applied to assess item targeting, threshold ordering, item fit, differential item functioning (DIF), local dependency (LD), unidimensionality, and reliability. Results: The EmpAQ SWE demonstrated acceptable measurement properties with adequate item targeting, covering most individuals in the sample and distinguishing approximately three clinically meaningful empowerment levels. Unidimensionality was supported, confirming that the instrument measures a single underlying construct. DIF was identified for Item 1 of the EmpAQ-5 between working and nonworking participants, while Item 6 of the EmpAQ-15 showed misfit and weak discrimination. LD was observed within empowerment dimensions but without broader residual correlations. The person separation index (PSI) was 0.77 for the EmpAQ-15 and 0.55 for the EmpAQ-5. Mean person locations were 1.6 (SD = 1.1) and 1.1 (SD = 1.3), respectively. Conclusions: The EmpAQ SWE demonstrated acceptable psychometric properties, supporting its validity for assessing self-reported empowerment among individuals with hearing loss in Sweden. Findings align with results from the original English version, reinforcing its clinical relevance. Future research should address item-level refinements to further enhance the instrument.

Background Assessment of work ability is complex yet crucial in occupational health and vocational rehabilitation. Evaluating psychometric properties is essential to ensure the accuracy of assessment tools in this field.Aim The aim of this study was to investigate the psychometric properties of the Finnish version of the Assessment of Work Performance (AWP-FI) with a focus on construct validity.Material and Methods The AWP assesses a client’s observable working skills during work performance in three domains: motor skills, process skills, and communication and interaction skills. Ninety-four AWP-FI assessments were performed by 17 occupational therapists in Finland. A Rasch analysis was conducted to evaluate the psychometric properties.Results The AWP-FI presented an overall fit to the Rasch model with acceptable item-fit statistics and items performing stably between gender, work tasks, and observation types. A suboptimal targeting was evident and issues concerning local dependency among items and indications of multidimensionality were indicated.Conclusion This study provides an initial validation of the AWP-FI, demonstrating generally acceptable psychometric properties, suggesting that the AWP-FI is valid and reliable for assessing work performance. Further testing is recommended to address the identified issues with local dependence and suboptimal targeting.

PURPOSE:Hearing loss affects communication and participation. Empowerment initiatives support individuals to manage their condition and facilitate patient-centered care. The Empowerment Audiology Questionnaires (EmpAQ-15/5), recently translated and validated in Swedish (EmpAQ SWE), were evaluated for convergent validity, internal consistency, and test-retest reliability. This study evaluates the convergent validity, internal consistency, and test-retest reliability of EmpAQ SWE. METHOD:A total of 136 adults with hearing loss completed an online survey twice. The survey consisted of EmpAQ-SWE and five measures assessing hearing disability, everyday functioning, hearing aid benefit, and general disability. For analysis, Spearman's correlation coefficient and Cronbach's alpha were used. RESULTS:There were significant correlations between the EmpAQ SWE and measures of hearing disability (r = -.389), everyday functioning (r = -.350), and hearing aid benefit (r = .542 and r = -.326). There were no significant correlations between the EmpAQ and general disability. The test-retest results for the EmpAQ-SWE indicated strong reliability (r = .760) and moderate internal consistency (α = .678). CONCLUSIONS:EmpAQ SWE demonstrated positive associations with everyday functioning and hearing aid benefit and negative associations with hearing disability. Although causality cannot be established, the findings support the convergent validity and reliability of EmpAQ SWE, underscoring its potential utility in clinical and research contexts.

Children with acquired brain injury (ABI) are at risk of developing cognitive, physical, or emotional impairments that affect their daily lives at home, school, and in society. PURPOSE:To explore this, we used the Swedish version of the Child and Family Follow-up Survey (CFFS-SWE) to describe the participation of 39 children (aged 5-17 years) who had sustained ABIs. MATERIALS AND METHODS:We assessed their participation using the CFFS-SWE at three points: upon discharge from the acute hospital, six months post-discharge, and between one and four years after discharge. RESULTS:Findings revealed that 69% of the children had rehabilitation needs at discharge, with physical symptoms, pain, mobility, and visual difficulties being the most common. Environmental barriers to participation included family stress, inadequate information about diagnosis and/or treatment, lack of assistance in school, and lack of family finances. Additionally, 31% of the sample had unmet support needs in everyday life. CONCLUSION:The study underscores the necessity of implementing structured follow-up and early rehabilitation interventions for children with ABI to improve their long-term outcomes.

Abstract Background To provide both preventive and rehabilitative conditions in a workplace, one must understand how employees experience work demands. Such an understanding can be obtained from each individual with valid and quality-assured questionnaires. The Work Environment Impact Questionnaire (WEIQ) is a new questionnaire for measuring employees’ self-perceived work ability in relation to their specific workplace environment. The purpose of this study was to assess the measurement properties in terms of construct validity of the WEIQ. Methods A cross-sectional survey study was conducted with 288 respondents from three different workplaces involving assisted living personnel, vocational rehabilitation personnel and personnel at a research institute. The measurement properties of the WEIQ were assessed according to Rasch Measurement Theory (RMT), including assessment of item-to-sample targeting, threshold ordering, item fit statistics, unidimensionality and reliability. Results Item fit, i.e., fit residuals, item characteristic curves (ICC) and chi square values, were all satisfactory, and no disordered thresholds were present after collapsing the lowest response categories. However, issues with local dependent (LD) item correlations was present in 7.6% cases, four items showed statistically significant differential item functioning (DIF), where 11% of the respondents had person fit residuals outside the recommended range of ± 2.5 and the t-test for unidimensionality did not meet the criterion of 5%. Scale-to-sample targeting and reliability (0.92) were good. LD could be resolved with testlets and at the same time maintaining fit and improving dimensionality, but then the reliability decreased to 0.82. Conclusions This study provides an initial validation of the WEIQ to be used for assessing employees’ self-perceived work ability. Most measurement properties were acceptable, but further exploration of LD, DIF and unidimensionality in additional work settings and with larger sample sizes is warranted. Trial registration Not applicable.

Many pupils experience restricted participation in Swedish schools due to a non-inclusive learning environment. Partnering for Change (P4C) is an evidence-based service delivery model, developed and employed successfully in Canada to create inclusive learning environments. P4C could potentially be used in Swedish schools, but its feasibility outside Canada is unknown. The aim of this study was to investigate the feasibility of P4C in Swedish compulsory schools. Fifteen interviews with teachers, occupational therapists (OT), and principals conducted after four months of applying P4C in seven classes, were analysed using deductive content analysis based on five feasibility areas. Quantitative questionnaire data concerning implemented interventions were analysed using descriptive statistics. Findings showed that participants considered P4C acceptable and its implementation possible. P4C integrated well with, and extended, schools' existing work on inclusive learning environments. Teachers and OTs implemented 83 interventions, indicating a need for improvements in the learning environment, which P4C helped to address, as positive effects for both pupils and teachers were noted. In summary, P4C was considered feasible in fostering inclusive learning environments in Swedish compulsory schools, offering potential value to the pupil health team without requiring further adaptions.

Background The assessment of work ability with reliable, thoroughly tested instruments, is central to evidence-based occupational therapy practice.Aims/Objectives The aim of this study was to investigate the psychometric properties of the Finnish version of the WRI with a focus on construct validity and measurement precision.Material and Methods Ninety-six WRI-FI assessments were performed by 19 occupational therapists in Finland. A Rasch analysis was conducted to evaluate the psychometric properties.Results The WRI-FI presented an overall fit to the Rasch model, with good targeting and separation among persons. The four-point rating scale structure was supported by the Rasch analysis, except for one item with disordered thresholds. The WRI-FI indicated stable measurement properties across gender. Seven of the 96 persons showed misfit, which slightly exceeds the criteria of 5%.Conclusions The findings from this first psychometric evaluation of the WRI-FI provided evidence of construct validity and support for measurement precision. The hierarchy among items corresponded with previous studies. The WRI-FI can offer occupational therapy practitioners a valid tool to evaluate psychosocial and environmental perspectives of persons’ work ability.

PurposeInformation and communication technology (ICT) has been proposed to enable an inclusive learning environment and increased participation for students with special educational needs. The aim of this study was to investigate the perceived need for ICT before and after an individualized ICT intervention among high school students with neurodevelopmental disorders and describe how the ICT was used to improve participation in school activities.Materials and methodsThis mixed-method study, with a one-group pre- and post-test design, included 99 high school students with neurodevelopmental disorders. Data from questionnaires and assessments using the School Setting Interview (SSI) were analyzed using descriptive statistics and the Wilcoxon signed-rank test. Deductive content analysis was performed on written notes in the SSI assessment.ResultsThe results showed that students' median number of perceived needs for ICT in school activities had decreased from six needs at baseline to one need at follow-up (t16.5 df(98), p<.001). There were five SSI items for which over 50% of the students perceived a need for ICT, with most students (95%) needing support in the item Remember things. Students received a laptop, tablet or smartphone (95%), software for planning or structure (84%) and ICT for writing and reading (66%). The ICT facilitated participation in multiple school activities, providing reminders and structure, facilitating notetaking and improving spelling. After the ICT intervention, students (61%) experienced improved study results and improved ability to manage difficult school situations (68%).ConclusionTo conclude, an individualized ICT intervention as support to increase school participation is promising among high school students with neurodevelopmental disorders.

BACKGROUND: Establishment in productive occupations i.e. work and further studies, is challenging for students who experience special educational needs (SEN). OBJECTIVE: The study aim was to investigate productive occupations and perceived work ability one year after upper secondary education among former students with SEN who had received a student-centred information and communication technology (ICT) intervention. METHODS: Questionnaire data on productive occupations (n = 81) were complemented with the semi-structured Worker Role Interview(WRI) concerning perceivedwork ability (n = 20), in an embedded mixed methods design. Group comparisons between participants who were and were not established in productive occupations were performed. Written notes from the WRI were analysed with a deductive content analysis. RESULTS: Findings demonstrated that almost two-thirds (63% n = 51) of the former students with SEN were established in productive occupations. The established group had to a higher extent obtained pass grades and had to a lesser extent received time-assisting ICT. Managing daily routines in combination with a productive role in a satisfactory manner was perceived as most challenging for the participants in relation to their work ability. CONCLUSION: The results indicate that students with SEN need person-centred support to handle difficulties both in and outside upper secondary school to promote the transition from school to establishment in productive occupations.

Abstract Background Inclusive learning environments are considered as crucial for children’s engagement with learning and participation in school. Partnering for change (P4C) is a collaborative school-based service delivery model where services are provided at three levels of intensity based on children’s needs (class, group-, individual interventions). Interventions in P4C are provided universally to support all children with learning, not only children with special education needs (SEN), and as such are expected to be health-promoting. Aim The aim of the study is to evaluate the effectiveness and cost-effectiveness of P4C as well as school staff members’ and children’s experiences after P4C. Methods In a parallel, non-randomised controlled intervention design, 400 children, aged 6–12 years, and their teachers, will be recruited to either intervention classes, working according to the P4C, or to control classes (allocation ratio 1:1). Data will be collected at baseline, post-intervention (4 months), and 11 months follow-up post baseline. The primary outcome is children’s engagement with learning in school. Secondary outcomes include for example children’s health-related quality of life and wellbeing, occupational performance in school, attendance, and special educational needs. The difference-in-differences method using regression modelling will be applied to evaluate any potential changes following P4C. Focus group interviews focusing on children, and professionals’ experiences will be performed after P4C. A health economic evaluation of P4C will be performed, both in the short term (post intervention) and the long term (11-month follow-up). This study will provide knowledge about the effectiveness of P4C on children’s engagement with learning, mental health, and wellbeing, when creating inclusive learning environments using a combination of class-, group- and individual-level interventions. Trial registration number NCT05435937.

.................................................................................................... 1 SAMMANFATTNING PÅ SVENSKA ........................................................... 4 LIST OF PAPERS .......................................................................................... 7 ABBREVATIONS .......................................................................................... 8 INTRODUCTION .......................................................................................... 9 Students with special educational needs (SEN) .................................... 9 Theoretical framework ......................................................................... 12 Person-environment interaction .............................................................. 12 Participation in school activities among students with SEN .............. 16 Supporting students with SEN in school activities .............................. 17 Students with SEN and accommodations in upper secondary school ..... 18 Establishment in work and further studies among students with SEN ....................................................................................................... 22 Rationale ............................................................................................... 24 AIMS ............................................................................................................ 25 METHOD .................................................................................................... 26 Design ................................................................................................... 26 Sampling ............................................................................................... 27 Participants ........................................................................................... 29 The ICT intervention ............................................................................ 30 The content of the ICT intervention ......................................................... 31 Intervention fidelity ................................................................................. 33 Data collection and procedure ............................................................. 33 Outcome measurements ........................................................................... 33 Procedure ................................................................................................ 39 Data analysis ......................................................................................... 40 Rasch analysis (studies I & III) ............................................................... 40 Descriptive statistics (studies I–IV) ......................................................... 41 Inferential statistics (studies II–IV) ......................................................... 42 Multivariate statistics (study II) .............................................................. 42 Participation and ICT: Students with Special Educational Needs in Upper Secondary School Embedded mixed methods (study IV) ...................................................... 43 Ethical considerations .......................................................................... 44 RESULTS .................................................................................................... 46 Student–environment fit among students with SEN in upper secondary school .................................................................................. 46 Students’ perceived need for support in school activities ....................... 46 Perceived student–environment fit in school activities ........................... 47 The School Setting Interview – valid measurement of student– environment fit ..................................................................................... 48 ICT as support in school activities for students with SEN in upper secondary school .................................................................................. 49 Productive occupations and perceived work ability one year after upper secondary school ........................................................................ 50 Motivation for work and further studies ................................................. 51 Daily routines influence on work and further studies ............................. 52 Social environment influence on work and further studies ..................... 53 DISCUSSION .............................................................................................. 54 General discussion ............................................................................... 54 Restricted participation in school activities among students with SEN in upper secondary education ..................................................................... 54 The influence of ICT on participation in school activities in upper secondary education ................................................................................ 60 Participation in productive occupations after upper secondary education among students with SEN ........................................................................ 63 Methodological considerations ............................................................ 64 External validity ...................................................................................... 64 Statistical conclusion validity .................................................................. 65 Mixed methods approach ........................................................................ 68 CONCLUSIONS .......................................................................................... 69 IMPLICATIONS .......................................................................................... 70 FUTURE RESEARCH .................................................................................. 71 ACKNOWLEDGEMENTS .......................................................................... 73 REFERENCES ............................................................................................ 75

BACKGROUND:Evidence-based information and communication technology (ICT) interventions to enhance school participation among students with special educational needs (SEN) are required. AIM:To evaluate the impact of an ICT intervention on school participation among upper secondary school students with special educational needs. MATERIALS AND METHODS:Data on 300 students' assessments with the School Setting Interview (SSI), grades and school attendance were used in this quasi-experimental study, with a one-group pretest-posttest design. Descriptive and inferential statistics and effect size were used, as well as Rasch analysis to generate interval data on the students' ordinal SSI ratings. RESULTS:In the ICT intervention (median time eight hours), 54% of the students received a tablet, and software concerned with planning and structure was received by 85%. After the ICT intervention, a significant decrease in perceived need for adjustments in school activities was found on a group level and 30% of the students improved their school attendance. Students who benefitted the most from the ICT intervention had few adjustment needs in school activities and no special educational support at baseline. CONCLUSION:An ICT intervention is promising for improving school participation among upper secondary school students with SEN.

The aim of this study was twofold: (1) to identify factors associated with a high level of accommodation needs in school activities among students with special educational needs (SEN) in regular upper secondary education; and (2) to investigate the extent to which schools have met students' perceived accommodation needs. Accommodation needs and their provision in school activities were assessed with the School Setting Interview for 484 students with SEN. Students' mean age was 17.3 years and 50% did not have a diagnosis. A logistic regression analysis revealed that a high level of school absence, studying a vocational programme, and a neuropsychiatric disorder were associated with a high level of accommodation needs. In the majority of school activities, about 50% of students had not received any accommodation despite an experienced need for support. About 30% of students perceived a need for support even though they had been provided with accommodations, and around 25% stated they were satisfied with received accommodations. Regular upper secondary school students with SEN are insufficiently provided with accommodations to satisfactorily participate in education. Specific student characteristics, e.g. high level of school absence, should receive special attention when investigating and accommodating students' needs for support in school activities.

BACKGROUND:Participation in education is a vital component of adolescents' everyday life and a determinant of health and future opportunities in adult life. The School Setting Interview (SSI) is an instrument which assesses student-environment fit and reflects the potential needs for adjustments to enhance students' participation in school activities. The aim of the study was to investigate the psychometric properties of the SSI for students with special educational needs in regular high school.METHODS:A sample of 509 students with special educational needs was assessed with the SSI. The polytomous unrestricted Rasch model was used to analyze the psychometric properties of the SSI regarding targeting, model fit, differential item functioning (DIF), response category functioning and unidimensionality.RESULTS:The SSI generally confirmed fit to assumptions of the Rasch model. Reliability was acceptable (0.73) and the SSI scale was able to separate students into three different levels of student-environment fit. DIF among gender was detected in item "Remember things" and in item "Homework" DIF was detected among students with or without diagnosis. All items had disordered thresholds. The SSI demonstrated unidimensionality and no response dependence was present among items.CONCLUSION:The results suggest that the SSI is valid for use among students with special educational needs in order to provide and evaluate environmental adjustments. However, the items with the detected DIF and the SSI rating scale with its disordered thresholds needs to be further scrutinized.

Background: Work ability assessments are used to guide interventions designed to reduce or eliminate work disability and facilitate work participation. The clinical utility of assessments concerns the extent to which the assessment results support clinical decision-making. Aim: The aim was to investigate how users perceive the clinical utility of the Swedish version of the Worker Role Interview (WRI-S). An additional aim was to investigate differences in clinical utility related to the users' level of WRI-S experience, attendance at courses on WRI-S application, and knowledge of the Model of Human Occupation. Material and methods: Data are based on 187 respondents' answers to a web-based questionnaire and analysed through descriptive and inferential statistics. Results: In total, the respondents performed 12 000 WRI-S assessments. The respondents were mainly satisfied with the clinical utility of the WRI-S and experienced the assessment as supporting clinical practice. The main hindrance affecting clinical utility was the amount of time needed for conducting a WRI-S assessment. Experienced users and users with very good knowledge of MOHO conduct WRI-S assessments in a more time-effective manner. Conclusion: This study contributes to further development of the clinical utility of the Swedish version of the WRI-S, mainly focusing on time consumption.