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Transforming school-based occupational therapy services

February 29, 2016

(Ontario,Canada) When McMaster School of Rehabilitation science professor Cheryl Missiuna set out to find a way to support children with special needs in schools, she didn't anticipate how her team's efforts would snowball into practice-changing research and a new service delivery model driven by the support of an extensive network of community partners.

"Our goal was to shift the focus away from intensive one-on-one treatment with long wait times," says Missiuna, who holds the John and Margaret Lillie Chair in Childhood Disability Research.

"Instead, we put the focus on changing the physical, social and learning environments of schools so that educators can better support children whose special needs may impede their development and participation."

"Nearly one in five school-aged children will experience challenges with mental health, physical health and other developmental issues that affect their ability to participate fully in school," explains Missiuna, who is also a scientist with CanChild, a research centre at McMaster that focuses on generating knowledge and transforming the lives of children with various developmental health conditions.

A multidisciplinary team of researchers at CanChild worked with families, school boards and the Community Care Access Centres that fund school-based occupational therapists to develop an innovative approach that serves all children who are struggling.

The service delivery model, called Partnering for Change (P4C), is a needs-based approach that eliminates wait times, provides a more holistic intervention, and facilitates earlier access to services, at no additional cost.

In the P4C model, Occupational Therapists (OTs) deliver services and collaborate with educators in context, which means that they work in all the spaces and places in a school where children learn and play.

A unique aspect of this model is its focus on capacity building and knowledge translation.

OTs help teachers learn to identify children with a diverse array of special needs and developmental issues.

They problem-solve with educators and model techniques for supporting whole classrooms of children, as well as for children who have higher needs. In addition, they connect with parents to explain reasons for children's issues and to share strategies that will help at home.

Three major studies completed over eight years have shown this novel research and service delivery approach to be highly successful.

In the most recent study involving 40 schools and three school boards, not only were wait lists eliminated in P4C schools, but 806 children with special needs were simultaneously given access to services and 8172 individual accommodation suggestions were shared with educators and families.

Educators reported an increase in knowledge and skills, while parents indicated they were better equipped to adapt tasks and the environment for their children.

"The participating OTs reported a strong sense of professional growth, including the contribution they can make to schools beyond serving individual children," adds Nancy Pollock, associate alinical professor and P4C investigator who was pivotal in developing the model and in training and mentoring the OTs.

The project's success is attributable to the community-based support received early on, points out Wenonah Campbell, assistant professor and one of P4C's lead McMaster coinvestigators.

"All of the stakeholders, parents, local health agencies, [government] ministries, and school boards, identified this as an issue of importance," she explains.

"Researching how to preserve the core of the intervention while sending it out into the community and sustaining its effectiveness is quite novel," points out Campbell.

Positive research results hinged on this collaboration since switching from direct one-on-one care to a classroom-based service model required a philosophical shift in the way OTs delivered occupational therapy services.

"Our partners had to change their reporting systems internally from a fee-for-service to a workload approach to allow this model to unfold," explains Campbell.

"This is hugely transformative regarding how OT services are delivered in the classroom."

P4C doesn't just represent a paradigm shift in how OT is practised, she adds, but ensures that the services delivered are wider-reaching and therefore more equitable.

P4C is being recognized as a service delivery model that may be applicable for other health professionals who work in schools.

There's also optimism that P4C could inform the work of local and provincial regions charged with providing more integrated rehabilitation services as part of the Ontario Special Needs Strategy.

Learn more about P4C at www.partneringforchange.ca

(Source: thespec.com)


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