Abstract
Recent federal initiatives demonstrate that improving adult outcomes for youth with disabilities is a high priority for the United States. The U.S. Office of Special Education Programs launched a new initiative in May 2023 to improve postsecondary outcomes for students with disabilities titled “Expect, Engage, Empower: Successful Transitions for All!” In addition, recent funding initiatives have allocated millions of federal dollars to improving postschool outcomes for youth with disabilities. Occupational therapy practitioners must be aware of these initiatives and the implications they have for their roles in school-based practice, vocational rehabilitation, and other practice settings where they serve children and youth. “Expect, Engage, Empower,” along with existing legislation, creates opportunities for occupational therapy practitioners to secure their role as leaders in supporting the transition to adulthood. The time is now for the occupational therapy profession to recognize this as a priority and work to ensure they are well represented in the area of postsecondary transition. In this article, we review existing legislation, new federal initiatives, and recent research evidence and demonstrate the need for occupational therapy practitioners to assert their role in postsecondary transition.
The authors review existing legislation, new federal initiatives, and recent research evidence and demonstrate the need for occupational therapy practitioners to assert their role in postsecondary transition.
Outcomes for youth with disabilities consistently lag far behind outcomes for youth without disabilities in completing high school, attending college, securing paid employment, and living independently (Bureau of Labor Statistics, 2024; Cheng & Shaewitz, 2022). These employment disparities continue into adulthood, with 21.3% of adults with disabilities being employed compared with 65.4% of adults without disabilities (Bureau of Labor Statistics, 2024). Given the large portion of the occupational therapy profession that is working to support children and youth (AOTA, 2023), it is critical that the profession prioritize guidance, resources, research, and training for occupational therapy practitioners in this practice area. Occupational therapy practitioners are well positioned to improve postschool outcomes for youth with disabilities; in fact, given their knowledge, skills, and domain of practice (AOTA, 2020), the relative absence of occupational therapy practitioners in transition planning is striking. Research based on the National Longitudinal Transition Survey 2 indicates that few students with disabilities (7.5%) receive occupational therapy during the transition years (Eismann et al., 2017).
The time is now for the occupational therapy profession to recognize this as a priority and work to ensure they are well represented in the area of postsecondary transition. Occupational therapy could be a key solution to reducing postschool outcome disparities for children and youth with disabilities, if we act now. In other practice settings, occupational therapy has been recognized as being valuable, cost-effective, and impactful for clients (Rogers et al., 2017; Szanton et al., 2014). Occupational therapy has the potential to provide similar value with respect to transition outcomes. Existing legislation, new initiatives, and recent research evidence demonstrate that transition to adulthood should be a priority for occupational therapy as a profession.
Existing Legislation
Two key pieces of federal education legislation have significantly affected the roles of occupational therapy practitioners who practice in public education: (1) the Individuals With Disabilities Education Improvement Act of 2004 (IDEA; Pub. L. 101-476) and (2) the Every Student Succeeds Act of 2015 (ESSA, Pub. L. 114-95) . IDEA ensures that students with disabilities receive a free and appropriate public education in the least restrictive environment. It requires that, no later than age 16, the individualized education program (IEP) must include postsecondary goals for employment, education, and, as necessary, independent living. Transition services, a coordinated set of activities based on each individual student’s needs, strengths, preferences, and interests, must also be included. IDEA identifies occupational therapy as a related service that can be included on the IEP and transition plan.
ESSA’s primary goal is to ensure an equitable education for all students, especially those at risk for lower academic achievement because of their socioeconomic status, race, disability, primary language, or background. Under ESSA, occupational therapy practitioners are included as specialized instructional support personnel (SISP). SISP support all children in schools, not just special education students, through prevention, collaboration, education, and intervention (Bazyk et al., 2022). SISP can promote positive postschool outcomes by collaborating with the educational team to design assessments and interventions that support evidence-based postschool readiness predictors (National Alliance of Specialized Instructional Support Personnel, 2024). Under ESSA, occupational therapy practitioners also have the opportunity to develop programs at a systems level for the successful transition of all students to adult life.
The Workforce Innovation and Opportunity Act of 2014 (WIOA; Pub. L. 113-128) is federal legislation designed to help all Americans, including youth with disabilities, obtain high-quality jobs and careers. Under this law, 15% of vocational rehabilitation (VR) funds must be used on Pre-employment Transition Services (Pre-ETS) for students with disabilities in public schools to supplement IEP transition services. These funds are allocated for job exploration and counseling, work-based learning experiences, opportunities for enrollment in postsecondary educational programs, workplace readiness training, and instruction in self-advocacy training and skills. Occupational therapy practitioners can serve as Pre-ETS providers or consultants, or they can collaborate with Pre-ETS providers within the school environment.
New Federal Policies and Initiatives
OSEP’s (2023) “Engage, Expect, Empower: Successful Transitions for All!” initiative challenges all providers, including occupational therapy practitioners, to raise expectations, engage families earlier, and empower all who support transition to significantly improve postsecondary outcomes for children and youth with disabilities and their families. OSEP specifically stated that education and VR systems must work together and that the transition planning process must start sooner.
Two recent federal grant opportunities support projects related to transition outcomes. First, the Disability Innovation Fund, funded by the Consolidated Appropriations Act of 2022 (Pub. L. 117-103), supports innovative activities aimed at increasing competitive integrated employment for youth and other persons with disabilities. Second, in August 2023, the U.S. Department of Labor announced an allocation of more than $69 million to support the development of innovative strategies to help youth and young adults with disabilities transition to the workforce successfully. These federal grant opportunities demonstrate that transition to adulthood is a national priority. It is important for occupational therapy practitioners to be aware of such funding opportunities and to collaborate within their states to apply for and be included in grant awarded projects.
Recent Research
Recent policy initiatives are informed by evidence-based practices for transition to adulthood. A systematic review by Mazzotti et al. (2021) identified 23 predictors of postschool success and the National Technical Assistance Center on Transition: The Collaborative (NTACT:C; 2021), has endorsed this research. All 23 of these predictors align with the Occupational Therapy Practice Framework: Domain and Process (OTPF–4; American Occupational Therapy Association [AOTA], 2020; Carroll & Schwind, 2023), and occupational therapy practitioners are skilled in designing evidence-based interventions that support these predictors.
Occupational therapy practitioners should use these predictors when working as members of collaborative teams and when providing interventions designed to prepare students for the transition to adult living. These predictors are relevant for children and youth of all ages across practice settings, especially because there has been a recent focus on promoting these skills at early ages (OSEP, 2023; Schwind et al., 2021). Several of these predictors can be implemented much earlier than the federal transition age of 16, within early childhood and elementary settings. The predictors fall into four clusters: (1) career development, (2) collaborative systems, (3) student skills, and (4) policy.
Career Development
The career development predictors include career awareness, occupational courses, paid employment/work experience, career technical education, and work study (NTACT:C; 2021) and align with the occupation of work (AOTA, 2020). Occupational therapy practitioners are skilled in identifying a person’s employment goals; analyzing job performance within the context of desired employment activities; customizing person-, task-, or environment-based interventions; and identifying workplace accommodations (Jirikowic et al., 2023). In addition, occupational therapy practitioners create individualized assistive technology and behavioral supports that improve employment participation (Jirikowic et al., 2023). They can contribute to the design of career development courses in the school system and community-based work experiences. Finally, occupational therapy practitioners have demonstrated expertise in matching individual strengths and interests with job demands (Persch et al., 2023).
Collaborative Systems
The collaborative systems predictors include interagency collaboration, parental expectations and involvement, student support, and transition programs. Collaboration is a key tenet of occupational therapy practice, and consultation is a service delivery method commonly used by occupational therapy practitioners (AOTA, 2020). AOTA’s Practice Guidelines for Children and Youth (Cahill & Beisbier, 2020) emphasize the importance of caregiver collaboration, coaching, training, and instruction for occupational therapy practitioners working with children and youth of all ages. Occupational therapy practitioners understand the complex dynamics between children and youth and the caregiver/family and know the importance of promoting caregiver involvement. In addition, the Accreditation Council for Occupational Therapy Education (2023) standards emphasize the importance of interprofessional collaboration; thus, occupational therapy practitioners are well prepared to collaborate on educational and interagency teams.
Student Skills
The student skills predictors include self-care and independent living skills, social skills, travel skills, and community experiences, all of which are occupations described in the OTPF–4. Both NTACT:C and Occupational Therapy Practice Guidelines for Children and Youth (Cahill & Beisbier, 2020) identify similar evidence-based interventions for self-care and independent living skills. Video modeling, interventions delivered within natural environments, structured practice, and the provision of coaching and feedback have been identified as evidence-based occupational therapy recommendations for self-care and independent living skills (Laverdure & Beisbier, 2021; Beisbier & Laverdure, 2020). Evidence indicates that engagement in occupations leads to improved social participation (Cahill et al., 2020). Occupational therapy researchers have also contributed to the development of a number of manualized, evidence-based interventions that support student skills related to transition to adulthood, including Project Team (Kramer et al., 2018), Pathways and Resources for Engagement and Participation (PREP; Anaby et al., 2018), and the Self-Determined Career Design model (Dean et al., 2019). Occupational therapy practitioners have the knowledge and skills to effectively design and implement evidence-based interventions to improve postschool outcomes.
The student skills predictors also include self-advocacy and self-determination and associated components, such as goal setting, youth autonomy and decision-making, psychological empowerment, and self-realization. Angell and colleagues (2019) emphasized that self-determination is a key component of occupational therapy practice and that occupational therapy practitioners are well qualified to evaluate, design, and provide interventions that support self-determination. Moreover, occupational therapy practitioners are skilled in creating and modifying environments to support self-determined actions, applying self-determination interventions beyond education and employment settings, applying task analysis to self-determination and self-advocacy skills, creating interventions that foster learning through doing, and effectively designing measurement and evaluation strategies for clients of all ability levels (Angell et al., 2019).
Policy
The policy cluster includes exit exam requirements, high school diploma status, inclusion in general education, and program of study. Occupational therapy practitioners understand how policies affect transition outcomes, and they possess the skills to advocate for both large-scale policy change as well as for individual students’ programs of study, diploma status, and inclusion. Occupational therapy practitioners are skilled in evaluations and interventions that support student inclusion in academic and nonacademic school activities (Cahill & Beisbier, 2020). They also support the inclusion of youth with disabilities in general education through skilled interventions that address literacy, academic engagement, environmental modifications, social participation, self-care skills, and sensory processing. The role of occupational therapy practitioners in school settings is expanding as a result of policies related to multitiered systems of support and services (Cahill & Beisbier, 2020), situating them as powerful service providers who create a large impact for all children and youth.
Call to Action
It is critical that the occupational therapy profession recognize poor postschool outcomes for individuals with disabilities as a priority for the profession. Swift action is needed for the field to align with recently announced policies, funding opportunities, and federal initiatives. Recommendations for occupational therapy practice, education, research, and outreach are as follows.
Practice
▪ Integrate predictors of postschool success and evidence-based practices into occupational therapy interventions. ▪ Use evidence-based assessments and interventions published by occupational therapy researchers, such as Voc-Fit (Persch et al., 2023), Project Team, PREP, and the Self-Determined Career Design model. ▪ Address transition with young children and their families. ▪ Ensure that occupational therapy evaluations include an occupational profile that is aligned with the student’s postsecondary vision. ▪ Write collaborative goals at all levels of education. ▪ Be knowledgeable about legislation and best practices related to transition. ▪ Consider potential transition needs before discharge from occupational therapy at younger ages. ▪ Use the resources listed in Table 1 to increase knowledge and skills related to transition to adulthood.
Resources to Support Evidence-Based Practices in Transition
Note. AOTA = American Occupational Therapy Association; OTP = occupational therapy practitioner.
Education
▪ Ensure that all occupational therapy students receive education about the role of occupational therapy in supporting transition to adulthood. ▪ Create capstone and fieldwork opportunities related to transition. ▪ Emphasize the importance of interprofessional education and skills for effective collaboration.
Research
▪ Establish research supporting occupational therapy intervention for self-care/independent living skills for children and youth because this is an identified predictor of postschool success, but it lacks evidence-based interventions. ▪ Research the impact of occupational therapists’ involvement as active members of the transition team for youth with disabilities, to demonstrate the added value of occupational therapy to transition outcomes. ▪ Align research with existing systematic reviews (Mazzotti et al., 2021) so occupational therapy’s value is recognized outside of the profession. ▪ Publicize occupational therapy research to interdisciplinary audiences, including NTACT:C and the Council for Exceptional Children’s Division on Career Development and Transition so that occupational therapists will be recognized as vital contributors to evidence-based transition practices.
Outreach
▪ Connect and share information with caregiver groups to enhance their understanding of occupational therapy’s role in transition. ▪ Advocate for occupational therapy’s role in transition with administrators, caregivers, colleagues, and community agencies. ▪ Communicate to policymakers the importance of creating grant opportunities that are inclusive of occupational therapy practitioners. ▪ Establish relationships with state VR agencies and Pre-ETS providers for collaboration and occupational therapy involvement. ▪ Advocate for policies that support occupational therapy as a recognized provider of transition services, including Medicaid reimbursement, VR services, and expanded roles for occupational therapy in school-based practice.
Summary
Occupational therapy practitioners are currently presented with a time-sensitive opportunity to demonstrate their distinct value in addressing the societal need for improved postschool outcomes for youth with disabilities. Occupational therapy is supported by existing legislation, aligned with new initiatives, and skilled in supporting all 23 predictors of postschool success. We must do all we can to ensure that the work we do with children and youth results in positive adult outcomes, especially given that success in future employment, education, and independent living is a key purpose of IDEA.
Footnotes
Acknowledgments
We thank Abe Saffer for reviewing the manuscript of this article and providing helpful comments that enhanced the quality of the article.