School-Based Occupational Therapy Practitioners’ Service Delivery Decision Making: A Qualitative Study

PURPOSE: This study examined factors that influence the decisions school-based occupational therapy practitioners make about service delivery (Bazyk & Cahill, 2015). The literature clearly indicates that collaborative models of intervention in inclusive school settings are the most efficacious manner of providing occupational therapy services (Hanft & Shepherd, 2008). Studies reveal, however, that most occupational therapy practitioners provide services using direct interventions outside of general classroom settings. Although the literature provides valuable descriptions of problems school occupational therapy practitioners encounter, it does not account for the interrelationship of belief systems and structural factors that impact service delivery choices. The following questions guided this study: How do school-based occupational therapy practitioners make decisions about service delivery? What factors influence the service delivery decisions occupational therapy practitioners make? What are occupational therapy practitioners’ perspectives regarding why and how they make service delivery decisions?

METHOD: We used a qualitative design with semistructured interviews with 14 occupational therapy practitioners. Participants were recruited from two school districts located near the researcher’s university. Recruitment was initiated via email after district approval as a research site. Participant experience ranged from 4 to 30+ yr. Three participants had a bachelor’s degree and 11 a master’s degree.

The primary data source was individual interviews. Participants also completed a questionnaire indicating years of practice as an occupational therapy practitioner, in schools, and in their current district; caseload size; and hours worked per week. Additional data included researcher journaling, publicly available school district data, and U.S. Census data. Data analysis was conducted using the Creswell (2007) data analysis spiral, an iterative process of open inductive data coding and analysis. Data were triangulated with interpretive journaling, discussion of findings, literature reviews, and listening to recorded interviews.

RESULTS: Participants relied on three strategies for service delivery. In the most used model, they pulled children out of classrooms for direct interventions. In the second most used model, they pushed direct services into classroom settings. In the least used model, they provided indirect services to school staff on behalf of children.

Factors that influenced participants’ decisions to pull children from classrooms included their sense of obligation as related service providers to provide short-term, skill-based interventions and their commitment to comply with service minutes as stated in individualized education programs. Participants also pulled children from classrooms as a means of gaining behavioral compliance with interventions. Pushing services into classrooms happened most often in special education classrooms. Participants’ rationale for pushing into self-contained classrooms was found to contradict their rationale for pulling children from general education classrooms. Decisions about consultation were made mostly when addressing sensory issues. Participants felt that consultation was most effective when school staff were receptive to their suggestions for carryover of activities into classrooms.

CONCLUSION AND IMPACT STATEMENT: The findings of this study can guide occupational therapy practitioners when critically reflecting on structural and personal factors that influence the service delivery decisions they make. Practitioners who recognize the interrelated factors affecting service delivery are better positioned to problem solve ways of providing services using inclusive and collaborative models. Understanding practitioners’ perspectives and belief systems regarding school-based practice is important when advocating for students, for evidence-based services, and for education policy.

References

Bazyk, S., & Cahill, S. (2015). School-based occupational therapy. In J. Case-Smith & J. C. O’Brien (Eds.), Occupational therapy for children and adolescents (7th ed., pp. 664–701). St. Louis, MO: Mosby/Elsevier.

Creswell, J. W. (2007). Qualitative inquiry and research design: Choosing among five approaches (2nd ed.). Thousand Oaks, CA: Sage.

Hanft, B., & Shepherd, J. (2008). Collaborating for student success: A guide for school-based occupational therapy. Bethesda, MD: AOTA Press.