Therapists' Perceptions of Contextually Based Service Delivery in School-Based Practice

PURPOSE: When school-based occupational therapy practitioners (SBOTs) provide intervention that occurs in natural environments, also known as contextually based intervention services (CBIS) (Seruya & Garfinkel, 2018), they are supporting legislative mandates (IDEA, 2004), and guidelines for best practice (AOTA, 2014; Handley-More et al., 2013; Polichino & Jackson, 2014). Many OTPs report that they provide CBIS in their practice (Seruya & Garfinkel, 2018); however, as OTPs intervene directly and on behalf of students in a variety of school-based settings, addressing academic and non-academic occupations, there may be a great deal of variation in how contextually based interventions are delivered. The purpose of this study was to gain a greater understanding of how CBIS is actually being utilized by SBOTs, and what the SBOTs' perceptions of CBIS are.

DESIGN: This study utilized a qualitative, phenomenological approach, using semi-structured interviews. Participants were recruited via networking, social media, and a snowball method. Inclusionary criteria for this study were SBOTs with at least one year of experience, who reported utilizing contextually based services in their U.S. based practice. All interviews were audio and video recorded.

METHOD: The primary instrument used was a researcher-developed semi-structured interview that was developed following a literature review and collaboration with experts in the field of school based occupational therapy. The questions captured demographic information, as well as qualitative information exploring experiences and perceptions of CBIS. Prior to engagement in the interview process, all participants signed a consent form. Interviews were conducted and transcribed by the occupational therapy students assisting in the research study. Once the interview data was collected and transcribed, it was coded analyzed for themes. Trustworthiness methods included member checking and peer debriefing.

RESULTS: Four SBOTs participated in this study. The four themes that emerged from analysis of the data are: a strong working relationship with other stakeholders is essential: CBIS are intentional; services need to be individualized; and there are systemic barriers to the provision of CBIS. These findings addressed the purpose of the research—to gain information about how CBIS are actually being used by SBOTs and what their perceptions of this service delivery model are.

CONCLUSION: The findings from this study demonstrated that, although contextually based integration services are viewed as best practice (AOTA, 2014; Handley-More et al., 2013; Polichino & Jackson, 2014), participants reported that barriers prevented them from using this model in practice. CBIS requires planning and intentionality to work collaboratively with teachers and other team members (Seruya & Garfinkel, 2020), and several participants reported that they did not have the time or resources to implement CBIS for that reason. Further, respondents reported varying between traditional and contextually based services, because they felt that best practice should allow practitioners to determine the best fit service delivery model based upon the client's needs, the environment, and the skills being targeted. The results from this study align with research indicating that CBIS is used less frequently by SBOTs than traditional, ‘pull-out' models (Seruya & Garfinkel, 2020). Implications for practice include the need to provide SBOTs with practical resources to help them overcome systemic barriers preventing them from providing CBIS; and the need to further explore the decision-making process by which SBOTs select appropriate service delivery models in practice.

References

Seruya, F.M. & Garfinkel, M. (2018).

Garfinkel & Seruya