Abstract
This study presents the results of a survey exploring practice trends, caseloads, service delivery models, and job satisfaction of school-based OT practitioners (OTPs) and how they relate to best practice. Findings indicate that most OTPs do not adhere to best-practice guidelines, such as providing contextually based interventions. Practitioners cited a lack of procedural knowledge and decreased advocacy skills as barriers to implementation of a workload approach that aligns to best practice.
Primary Author and Speaker: Francine Seruya
Additional Authors and Speakers: Mindy Garfinkel
Reframing the job-related responsibilities of school-based occupational therapists in terms of a workload, rather than a caseload, leads to more efficient and impactful service delivery that aligns with evidence-based practice (AOTA, APTA, & ASHA, 2014; Jackson, Polichino & Potter, 2006, Polichino & Jackson, 2014). Workload refers to all of the activities practitioners engage in that support students directly and indirectly, and caseload refers to the number of students treated by a therapist (Garfinkel & Seruya, 2016; Polichino & Jackson, 2014). This paradigm shift, provides more opportunities for therapists to implement occupation-based interventions in natural environments, by expanding the role of the therapist beyond direct treatment to include engagement in programs that promote positive student outcomes in a larger community, such as participation in curriculum development; Multi-Tiered Support Services (MTSS); mental health; and positive behavioral intervention services (AOTA, 2012; AOTA, et al., 2014; Handley-More, Wall, Orentilcher, & Hollenbeck, 2013; Polichino & Jackson, 2014). The use of a Population Health approach to engage in school-wide programming allows practitioners (OTPs) to reach a larger group of children earlier and prevent some of them from requiring more intensive services (AOTA, 2012). Further, adoption of a workload model supports therapist job satisfaction (AOTA, et al., 2014).
Therapists have reported a variety of barriers that limit their ability to successfully implement and or advocate for a workload approach in their setting, such as high caseload numbers; differing perceptions of how therapists’ time should be used; decreased administrative support; scheduling conflicts; and a lack of resources (Garfinkel & Seruya, 2018).
There is limited evidence that has recently explored caseload size, service delivery models in elementary, middle and high school settings (Giordanella, Dulanie, Chubet, Rotko & Seruya, 2015; Rodrigues & Seruya, 2017; Seruya & Ellen, 2015), practitioner inclusion in school community service provision (Rodrigues & Seruya, 2017; Seruya & Ellen, 2015), and the use of a workload model in school-based practice (Garfinkel & Seruya, 2018; Garfinkel & Seruya, 2016).
This study presents results of a survey exploring current practice trends; caseloads; attributes of caseloads; service delivery models; knowledge of state and local policies; and job satisfaction of school-based OTPs and how they relate to best-practice. Three hundred seventy-one practitioners, from across the United States recruited via social media platforms, state associations, and snowball sampling completed a web-based, online survey. Results indicate that participants primarily provide services in elementary schools and were directly hired by their districts. Average caseload size of 30-50 students was reported. Findings also indicate that despite current philosophy regarding best practice, OTPs continue to provide services outside of the classroom and other natural settings. Primary barriers to implementing a workload approach were reported as lack of administrative support, high caseload numbers, and lack of time. Implications for occupational therapy practice are that practitioners indicated a desire to move their practice to a workload model, thereby aligning with best practice, however, they cited lack of procedural knowledge and decreased advocacy skills as barriers to implementation.
American Occupational Therapy Association, American Physical Therapy Association, & American Speech-Language-Hearing Association (2014). Workload approach: A paradigm shift for positive impact on student outcomes. Retrieved from: http://www.aota.org/-/media/Corporate/Files/Practice/Children/APTA-ASHA-AOTA-Joint-Doc-Workload-Approach-Schools-2014.pdf
Polichino, J.E., & Jackson, L. (2014). Frequently asked questions: Transforming caseload to workload in school-based occupational therapy services. Retrieved from: https://www.aota.org/∼/media/Corporate/Files/Secure/Practice/Children/Workload-fact.pdf
Garfinkel, M. & Seruya, F.M. (2018). Therapists’ perceptions of the 3:1 Service Delivery Model: A workload approach to school-based practice. Journal of Occupational Therapy, Schools, & Early Intervention, 11:3, 273-290, DOI: 10.1080/19411243.2018.1455551