Key Recommendations
As a result of the findings detailed throughout this report, the research team would like to highlight the following recommendations, many of which have direct policy implications:
Partnering for Change is a model of service provision that is responsive to local contexts and culture.
Partnering for Change is a model of service provision that is responsive to local contexts and culture.
P4C occupational therapists (OTs) were asked to rate the extent to which they had achieved each of the goals of Partnering for Change, in each of the schools in which they provided service. The variability of responses reflects differences that were encountered in each school culture. The same OT provided service to more than one school (up to four) and was able to be flexible in approach in response to the culture of the school and the socio-demographic factors affecting children and families in different regions and school boards.
Many children are able to be reached in the P4C model of service. P4C OTs provide support to the whole classroom, which is particularly important for younger children who may or may not have special needs.
Many children are able to be reached in the P4C model of service. P4C OTs provide support to the whole classroom, which is particularly important for younger children who may or may not have special needs.
The P4C service is provided at a whole classroom level which means that it reaches children who might otherwise be under-identified as well as those who do not require identification, just a bit of support. The tiered approach means that children receive the amount of support that they need, when they need it, which is one of the aims of the Special Needs Strategy. Having the OT in the classroom on a regular basis will also serve as a resource for educators who are moving toward inclusive education. In the P4C study, OTs spent nearly 10% of their time each day working to build the capacity of educators to understand and manage children with special needs in the regular classroom.
A tiered model is appropriate, with an emphasis on universal design for learning and the suggestion of strategies that are “good for all but essential for some” children. Several parents who were approached did not wish to have their child receive individual accommodations but asked the P4C OT to ensure that their child continued to receive appropriate OT support in the classroom. While the OTs identified many young children who were struggling in full day kindergarten, they were able to support them and monitor their progress, without “identifying” the child as having special needs. If the child did not respond to the classroom-wide intervention, however, the OT could easily increase the level of involvement, without waiting for the child to be in Grade 1 and have to be referred to a waitlist.
The frequency of P4C service at the school is important for capacity building. Educators appreciated the consistent, regular service delivery in their schools.
The frequency of P4C service at the school is important for capacity building. Educators appreciated the consistent, regular service delivery in their schools.
Educators and occupational therapists repeatedly emphasized how important it was to be a regular and consistent presence in the school. In this study, that presence was weekly and the findings, which demonstrated that capacity of educators was building incrementally, may not generalize to alternative models of service delivery. There are many factors which affect the OTs’ ability to manage a number of schools and these need to be systematically studied.
P4C provides equitable and seamless access for families. The majority of parents were satisfied with the service provided by the P4C therapists.
P4C provides equitable and seamless access for families. The majority of parents were satisfied with the service provided by the P4C therapists.
The demographic information that was collected in this project indicates that P4C OTs were able to provide service to families who might not otherwise request it. In P4C the therapist: is the point of first contact, which negates the need for lengthy and resource-intensive referral mechanisms before the child is able to receive support; works with educators and whole classrooms of students in schools, providing support that increases all children’s participation and achievement; provides service without the need for diagnosis of health care conditions or formal psycho-educational assessments before supports are able to be put in place. The family can raise concerns about their child with the health professional without going through a formal review process. There is no waitlist, if the OT is present on a regular basis.
83.7% of parents reported that the P4C occupational therapy service was beneficial to their child and/or family. 83.1% were satisfied with the service to a moderate or great extent. Although many parents were very satisfied, some parents expressed a desire for more information. Future studies should continue to find innovative ways to help OTs and parents to connect with one another, particularly since the findings of our study support how valuable the resources and connections with the OT were to parents.
Occupational therapists have the skills and training to address varied needs of children in school settings, including mental, social and physical health issues.
Occupational therapists have the skills and training to address varied needs of children in school settings, including mental, social and physical health issues.
The OTs delivered many services in an expanded role. They identified children far earlier and provided support in the context of the classroom right away. Some OTs identified slightly older children who were beginning to show the secondary consequences of DCD, including lowered self-esteem. These children were sometimes bullied and two children in Grade 3 were identified who had suicidal ideation. OTs demonstrated in this project that they can suggest strategies in far more areas than just written productivity. OTs could be better utilized throughout the school system, including in middle school and high school to address many of the mental health issues that impact on school performance. They are able to provide support for children with executive function issues, inattention, organizational problems, anxiety, as well as to recommend technology or software that reduces some of these difficulties.
Waitlists can be eliminated in this model with no additional costs.
Waitlists can be eliminated in this model with no additional costs.
By the end of the first year of implementation both the Central West (CW) Community Care Access Centre (CCAC) and the Hamilton, Niagara, Haldimand and Brant (HNHB) CCAC reported that waitlists were eliminated in the 40 participating research schools. All stakeholders were very satisfied with this outcome.