What is P4C?

Description of the Partnering for Change Model

The Partnering for Change model is an innovative way of delivering rehabilitation services to support all children with special needs, beginning in full day kindergarten. The service is provided in the context of the classroom, with the school as the “client”.

  • P4C uses a tiered approach that allows OTs to reach far more children.
  • P4C reflects partnerships and collaboration between health professionals, educators and families.

Illustrating the P4C Model

The Partnering for Change team used evidence from the literature to design a conceptual model that was tested in school settings and refined. The figure reflects the partnership that is needed between therapists, parents and educators to create environments that will facilitate successful participation for all students.

Working from a foundation that focuses on relationship building and sharing of knowledge, these partners collaboratively design environments that foster motor skill development in children of all abilities, differentiate instruction for children who are experiencing challenges and accommodate for students who need to participate in a different way.

While the school remains the target of intervention, allowing therapists to impact the greatest numbers of children, therapists are able to increase the intensity of the service that they provide as they coach educators and/or parents about individual students who have more complex needs. In this model, all collaboration and intervention occurs in the context of the school setting.

Description of the P4C Model

  1. The Model Explained
  2. Partnership
  3. Relationship Building
  4. Knowledge Translation
  5. Universal Design for Learning
  6. Differentiated Instruction
  7. Accommodation
  8. Needs-Based Intervention
  1. The P4C Model
    © 2011 Missiuna, Pollock, Campbell, Levac and Whalen, CanChild, McMaster University.

    The Model Explained

    The P4C acronym represents the “4 Cs” that comprise the Principles of Partnering for Change: Building Capacity through Collaboration and Coaching in Context.

    The French translation maintains the P4C title and acronym: Partenaires pour le Changement. The principles (“4Cs”) are: developpement de Capacites; Collaboration; and Coaching en Contexte.

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  2. The P4C Model: Partnership
    © 2011 Missiuna, Pollock, Campbell, Levac and Whalen, CanChild, McMaster University.


    The outer circle of the P4C Model represents the partnership between educators, therapists, parents and students who work together to support children’s participation at school and at home. By wrapping services around the student from the point of school entry, P4C aims to prevent more complex health and academic issues from developing.

    Two core activities form the foundation for all other interventions offered within the P4C model, relationship building and knowledge translation.

  3. The P4C Model: Relationship Building
    © 2011 Missiuna, Pollock, Campbell, Levac and Whalen, CanChild, McMaster University.

    Relationship Building

    Our research shows that the therapist needs to be a regular and consistent presence in the school, available and seeking opportunities to connect with educators and parents. The therapist is responsive to the school’s needs; provides services to students in the right place at the right time; offers regular and timely follow up.

    Relationship building involves enhancing educators’ understanding of the therapist’s areas of expertise. This is done through hallway interactions, sharing of resources, as well as provision of short, lunch and learn sessions that are offered by the therapist in response to questions that arise during the day and topics of interest to the educator. Examples include: typical child development; pre-printing tasks, modifying activities or developmental red flags.

  4. The P4C Model: Knowledge Translation
    © 2011 Missiuna, Pollock, Campbell, Levac and Whalen, CanChild, McMaster University.

    Knowledge Translation

    The health professional needs to be able to provide evidence-based information about how to support students’ participation in a way that educators can use in the classroom and that a parent can use at home. The goal of Knowledge Translation is to build the capacity of others by problem-solving together, identifying and trying out strategies that enable successful student participation. A key difference in this model is that the therapist explains how, why, when, and where particular strategies work, sharing knowledge in order to facilitate understanding of the student’s needs and actually demonstrating the solution in context. Educators and families can then apply these strategies when appropriate and adopt this knowledge in their day-to-day activities.

  5. The P4C Model: Universal Design for Learning
    © 2011 Missiuna, Pollock, Campbell, Levac and Whalen, CanChild, McMaster University.

    Universal Design for Learning

    The types of services included in the P4C model are based on a Response to Intervention pyramid. Services in P4C are provided universally to support all children in a classroom, with increasingly intensive services being added for children whose needs are not able to be met through class-wide strategies. Because services are based on need, students with higher needs receive increasingly intense levels of support. The first tier, shown at the base of the response to intervention triangle, is Universal Design for Learning.

    Universal Design for Learning (UDL) refers to an approach to designing educational materials, instruction and classrooms to benefit all students. Its purpose is to allow equal access to learning and to remove barriers that prevent students from participating or accessing the curriculum. Use of UDL principles leads to the development of educationally relevant strategies and tools that meet the needs of all learners who differ widely in their physical, cognitive, behavioural, and communicative abilities. UDL strategies are those that are “good for all and essential for some”.

    UDL enhances the capacity of all students to fully engage in the education curriculum while simultaneously reducing the need for individual accommodations and remediation.

  6. The P4C Model: Differentiated Instruction
    © 2011 Missiuna, Pollock, Campbell, Levac and Whalen, CanChild, McMaster University.

    Differentiated Instruction

    The second tier of the response to intervention triangle is Differentiated Instruction. At this tier, the therapist and educator begin to look at smaller groups of students who are having difficulty performing grade-level activities, despite prior exposure to class-wide strategies at the Universal Design for Learning tier.

    Educators recognize that a child is struggling but may not always know why or what is the cause of the problems they are seeing. At the Differentiated Instruction tier, the educator and therapist collaborate to determine different practices that would be reasonable alternatives to the regular methods of instruction. They may also use small groups to introduce skills that are difficult for a few children and watch each week to see how each child responds to the intervention.

    From a health care perspective, this tier is referred to as “determination of need” for more individualized services. If the child is determined to need more individualized intervention, health care consent must be received. Other processes may also need to go into place (e.g. notify principal, notify health care funder) and an individual file is opened for documentation purposes.

  7. The P4C Model: Accommodation
    © 2011 Missiuna, Pollock, Campbell, Levac and Whalen, CanChild, McMaster University.


    The third tier at the top of the response to intervention triangle is Accommodation. At this tier, the therapist focuses on individual students who have more complex needs. If a child has been provided with appropriate experiences, yet continues to have difficulties, the therapist determines the need for services to be provided at this tier. The therapist works collaboratively with families and educators to provide appropriate accommodations that address continued concerns. At this level, health care consent is always sought and families agree to have their child receive service.

    At this level, the therapist conducts observational assessment in context — wherever the issue is occurring. This process is called dynamic performance analysis, which means that the therapist actually tries implementing specific strategies involving a change in the task or environment; the child’s response is monitored, and the outcome of the change is determined. If the strategy was not successful, something else is trialled. An important component in P4C is that therapists then communicate with the educator, parent and team about what was done, and why, to build capacity through knowledge translation. Strategies that are found to be successful may be noted on the child’s Individual Education Plan so the next teacher is aware of the service that was provided.

  8. The P4C Model: Needs-Based Intervention
    © 2011 Missiuna, Pollock, Campbell, Levac and Whalen, CanChild, McMaster University.

    Needs-Based Intervention

    In the final layer of the P4C model, arrows can be seen at the sides of the Response to Intervention pyramid. These arrows show that as the intensity of the P4C service increases, the number of students needing services at that level simultaneously decreases.

    By using a tiered approach, the P4C model enables many diverse student needs to be met by ensuring that the level of support is needs-based and reaches all students – from those who need only classroom-wide supports to those who need customized strategies to maximize their potential.