Date Presented 4/20/2018
This study examined the current practice patterns of school-based occupational therapy practitioners in two Western states related to use of push-in versus pull-out services. The study also identified their perceptions of facilitators and barriers to providing more push-in services.
Primary Author and Speaker: Heather Watt
Contributing Authors: Lorie Gage Richards, Heidi Woolley, Sarah Gray
PURPOSE: In the past decade, there has been a push for students with individualized education programs to be more included in general education classrooms with nondisabled peers. A similar argument is for occupational therapy also to occur in the classroom so that students learn skills in the context in which they will use the skills (Mu & Royeen, 2004a, 2004b). Two older studies showed that occupational therapists provided more pull-out than push-in therapy (Case-Smith & Cable, 1996; Spencer et al., 2006). It is time to examine whether occupational therapy in schools has changed. Moreover, neither of the past studies examined barriers to or facilitators of providing push-in services. Thus, this study’s purpose was to address the following questions: What is the current level of pull-out and push-in service provision by school-based occupational therapy practitioners? What are the facilitators of and barriers to using push-in services in school systems?
METHOD: This study used a mixed methods design. Occupational therapists and occupational therapy assistants working in school districts in Colorado and Utah completed an online survey of demographic and school practice information. Participants willing to complete an interview provided contact information. Interview questions focused on decision making about service delivery models and perceptions of what aided or hindered providing push-in services. Survey data were tallied. Interviews were transcribed and coded for themes related to facilitators of and barriers to push-in services. Each interviewee was contacted for member checking.
RESULTS: The 46 occupational therapists and 2 occupational therapy assistants completing the survey indicated they provided more than 35% of services in an occupational therapy area and nearly 50% of services within special or general education settings. Eighteen occupational therapists and one occupational therapy assistant were interviewed. In general, participants were positively inclined toward providing push-in services, although they did not believe these services were best for meeting the needs of every child. Participants in Utah worked longer hours with nearly double caseloads consisting of more children in higher grades than those in Colorado. There were small differences in therapy location and type of therapy provided.
Despite these differences, emergent themes were consistent between participants in Colorado and Utah. Themes were a sense of practitioner positivity, students’ needs, education and training, school environment, relationships and attitudes, and workload. Each theme could be a facilitator or barrier depending on its presence or absence. Facilitators included the practitioner’s understanding of how to implement push-in services and the education system’s backing of the use of this delivery system. Barriers included lack of practitioner training, lack of school support for push-in services, high caseloads, and variable classroom and practitioner schedules. Reported facilitators and barriers were similar for participants in Colorado and Utah.
CONCLUSION: These findings indicate that although these occupational therapy practitioners viewed push-in delivery as favorable for some services, barriers to implementation limited its use as a primary model for school-based practitioners in Colorado and Utah. School districts need to provide more support if they desire this type of service, to assist in teacher training on this service model’s benefits, and to better manage workloads to allow occupational therapy practitioners to implement push-in services. Educational programs need to provide occupational therapy practitioners and teachers with the tools to implement this model of practice.
IMPACT STATEMENT: Significant elimination of barriers in school settings is needed before push-in delivery becomes the primary service delivery model. Increased research into the benefits of push-in services is needed to support strong arguments for elimination of these barriers.
References
Case-Smith, J., & Cable, J. (1996). Perceptions of occupational therapists regarding service delivery models in school-based practice.OTJR: Occupation, Participation and Health, 16, 23–44. https://doi.org/10.1177/153944929601600102
Mu, K., & Royeen, C. (2004a). Facilitating participation of students with severe disabilities: Aligning school-based occupational therapy practice with best practices in severe disabilities.Physical and Occupational Therapy in Pediatrics, 24–(3), 5–21. https://doi.org/10.1300/J006v24n03_02
Mu, K., & Royeen, C. (2004b). Interprofessional vs. interdisciplinary services in school-based occupational therapy practice. Occupational Therapy International, 11, 244-247. https://doi.org/10.1002/oti.214
Spencer, K. C., Turkett, A., Vaughn, R., & Koenig, S. (2006). School-based practice patterns: A survey of occupational therapists in Colorado. American Journal of Occupational Therapy, 60, 81-91. https://doi.org/10.5014/ajot.60.1.81
