Each working day, P4C OTs recorded the services that they provided to the schools in an online daily log. They were asked to report what they did with their time: working at a full classroom level; working with small groups either to differentiate instruction or to screen children to determine their need for more individualized services; working at the accommodation level in support of individual children for whom health care consent had been received; and providing education to build capacity. We know from reviewing a random selection of charts that the daily logs under-estimated the services that were provided.
Across the two years of the study, the daily logs show:
- 806 individual children with special needs received OT services at 40 schools.
- 8,172 individualized strategies and accommodations were suggested and implemented for those children with special needs.
- 6,697 opportunities were provided to screen small groups of children who were having difficulty in the classroom and to trial differentiated instruction and share findings with educators.
- 1,291 activities were provided at a whole class level, with OTs leading the class and modelling strategies for inclusive education.
- 662 educator in-services (formal and informal) were offered to build capacity.
- JK – 8 Grades in which OTs provided support to children.
Year 1 Services
Starting in November 2013 and continuing for the remainder of the 2013–2014 school year, 15 OTs delivered the P4C service one day per school per week (1,207 workdays in total) in 40 schools. They provided:
- 592 individual children with special needs received OT services.
- 3,574 individualized strategies, suggestions and accommodations were suggested and implemented. OTs then shared successful strategies with educators and families.
- 2,995 opportunities to screen small groups of children who were having difficulty, trial differentiated instruction, monitor children’s response to intervention, and share findings with educators.
- 704 activities at a whole class level, modelling strategies for inclusive education.
- 391 educator in-services (formal and informal) to build capacity.
In Year 1, the number of times services were provided in support of children who were at the individual accommodation level ranged from 1–22. On average, each child received 5.8 services but there was wide variability. This shows that children were seen many times, if needed. Also included in this count are times when the OT may have supported individual children indirectly by communicating with families and educators, arranging technology or preparing resources. Importantly, this number does not reflect services children would have received via activities and suggestions that happened either at the Universal Design for Learning (UDL) or Differentiated Instruction (DI) tiers of the model, before the OT sought consent to provide more intensive services. The variability in the average number of OT services offered to individual children is consistent with the needs-based approach utilized in this model.
Children who were identified as struggling by their educator were seen quickly and did not need to wait for service. Wait lists for OT services were eliminated in all P4C schools.
Year 2 Services
In the 2014–2015 school year, staffing changes resulted in some of the P4C OTs maintaining fewer schools. In total, 17 OTs delivered the P4C service one day per school per week (1,443 workdays in total) in 40 schools and provided:
- 716 individual children with special needs received OT services.
- 4,598 individualized strategies, suggestions and accommodations were suggested and implemented. OTs then shared successful strategies with educators and families.
- 3,702 opportunities to screen small groups of children who were having difficulty, trial differentiated instruction, monitor children’s response to intervention, and share findings with educators.
- 587 activities at a whole class level, modelling strategies for inclusive education.
- 271 educator in-services (formal and informal) to build capacity.
In Year 2, OTs maintained the children identified in Year 1 but also worked with educators to identify other children who were finding school activities to be challenging. These children may have been identified as needing occupational therapy for varied reasons in Year 2. Support of the 806 children who received service at the individual accommodation level ranged from 1–23 activities per child. For example, one visit may have consisted of a check-in with next year’s teacher to ensure that the Individual Education Plan (IEP) suggestions remained relevant and that no new issues had emerged. Another activity might have been a meeting with the parent and teacher. OTs also continued to provide whole class and small group activities in which these same children might have participated; these additional services are not captured in counts of visits. An average of 6.1 services were provided to any individual child at the accommodation level. There was even greater variability noted with respect to the number and type of services offered in Year 2; however, as noted previously, this is consistent with a needs-based approach.
Comparison of Year 1 and Year 2 Services
The P4C OTs were assigned to and provided support to the same elementary school during the two years. The OT daily log data show that more educator in-services and whole class activities were offered in the first year of service, in comparison with data from Year 2. This finding is consistent with the emphasis in Year 1 on the two core activities that form the foundation for all other interventions offered within the P4C model: relationship building and knowledge translation. More in-services and educational activities were required in the initial year because the OT needed to familiarize the school community with the role of the P4C OT. Fewer educational activities or in-services may have been needed in Year 2 as a result of increased educator capacity or because there was reduced staff turnover at some schools, which lessened the need for education about the differences in the P4C OT role.
The OTs engaged in more UDL-focused whole class activities in Year 1 to support educators in adjusting the social and physical environment of their classrooms or their method of instruction to further support students with motor, attentional or other challenges.
While still necessary in Year 2, fewer whole class activities were needed, perhaps because educators integrated learning from Year 1 into the design of their classrooms and educational curriculum in Year 2. P4C OTs clearly engaged in more screening activities in the first year to identify children in need of more intensive support. Children with greater needs continued to be supported in Year 2; as a result, more individualized strategies were provided for children at the accommodation level.
The OT daily logs illustrate the many varied activities required of a P4C OT. This would include providing in-services and “lunch and learn” educational opportunities; attendance at in-school resource team meetings; and communication with families. The varied activities that comprise the role of a P4C OT have implications for workload management and planning, and are illustrated further in Making a Difference for Health and Education.