A Paradigm Shift
In Year 1, 15 OTs provided P4C services, one day each week at the same elementary school. OTs were assigned to each school and provided services starting in November, 2013.
Staffing changes resulted in additional OTs being trained and providing service in the second year of the study. In Year 2, 17 OTs provided P4C services at the same frequency (one day per week) in the same 40 elementary schools; some OTs had fewer schools than in the previous year. These OTs were able to start at their P4C school during the last week of August, 2014 to enable relationship building and support with classroom design.
The research ethics board requirements and discussions with the College of Occupational Therapists of Ontario resulted in the following process: All parents in each school received a letter at the start of each school year describing the P4C Model of service. The letter explained the role of the P4C OT and informed parents about the types of activities and services that the P4C OT would be providing. The letter clearly stated that, if any child was having more problems learning motor skills than was typical for his/her age; parents would be contacted. Families were also provided with contact information if they had any questions. Families whose children had not received service but who were concerned that their child had motor challenges were also invited to contact the P4C OT or project coordinator (family or self-referral). This letter served to notify families about the OT services being provided at the Universal Design for Learning and Differentiated Instruction tiers of the P4C Model.
During the project, children in each school who were on either the active caseload or waitlist of the CCAC for school health occupational therapy services (and who were anticipated to have motor coordination difficulties) were transferred to the P4C OT for service. Parents of these children provided consent first to the CCAC and then to the P4C OT in order to receive P4C health care services. Children who were passed on to the P4C OT had been on the waitlist from one to two years on average.
The P4C OTs also observed children in classrooms and, in collaboration with educators, identified additional children who required occupational therapy services. P4C OTs contacted parents directly to seek health care consent and then informed the CCAC that the child would be able to receive P4C services right away. There is no need for a waitlist in the P4C model of service. The family also knows who will be providing the service and has spoken to that OT to give health care consent.
At the end of Year 1, early results were examined and discussed with the Steering Committee and the Working Group, as well as designated representatives from each school board. Any recommended changes were implemented (e.g. a presentation and question-and-answer session was given by investigators to familiarize all principals in the Peel District School Board with the P4C Model). OT training and mentorship was also modified to enhance the OTs’ ability to provide P4C services. Some school and CCAC procedures also changed in Year 2 and are described in the Findings section.