Académique Documents
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Date: 09/21/1014
Focus Question: Is a consultation treatment model an effective service delivery method for children receiving school-based occupational therapy services?
Rationale for inclusion/exclusion criteria applied to determine which articles should be included in the evidence table:
Inclusion Criteria: This criterion was based on selecting articles that would increase the confidence in the final result. Inclusion criteria supported the focus questions,
increased the quality of the CAT, and were acceptable to review.
Exclusion Criteria: This criterion was not relevant to answering the focus question and was therefore not included in the CAT.
Clinical consultation
Author/
Study Objectives
Year
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
Level II
Intervention:
The intervention
success rate was
63%.
Kemmis &
Dunn (1996).
Investigate if a weekly
collaborative
consultation between
elementary school
teachers and
occupational therapists
(OTs) is a successful
service delivery model
for children to meet
their Individualized
Education Plan (IEP)
goals.
Design:
Cohort Study
Subjects:
7 boys and 3 girls
Weekly 60 minute
meetings with
teacher/therapist pairs
would meet to develop
specific intervention
strategies for the
teacher the following
week.
Remedial and
compensatory
interventions
were equally
successful across
performance
areas with
Subjects obtained
through a
convenience sample.
Children receiving OT
services through
collaborative consultation
successfully met their IEP
goals.
Program Development:
Author/
Year
Study Objectives
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
5 to 9 years old
collaborative
consultation.
Had a learning
disability, behavior
disorder, or
developmental
delay.
Teacher evaluated
whether the student met
the goal according to
the criterion set by the
teacher and therapist.
Outcome Measures:
Based on IEP goal
attainment, and whether
a remedial or
compensatory
technique used using
the intervention
documentation form.
Study Limitations
Implications for OT
Weekly collaborative
consultation between the OT
and teacher provide a strong
foundation for successful IEP
goal attainment.
Societal Needs:
Weekly consultative
meetings were beneficial to
the teacher to provide them
with resources to support
interventions and progress
towards IEP goals.
Author/
Study Objectives
Year
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
Refinement, Revision,
and advancement of
Factual Knowledge or
Theory:
A future study should be
completed to compare
remedial and compensatory
interventions within a schoolbased OT collaborative
consultations service delivery
model.
Villeneuve
(2009).
Critically appraised 2
case studies regarding
collaborative
consultation OT
services in schoolbased setting to
provide program
administrators with
information to aid in
decision making for
service delivery.
Level V
Design: Narrative
Literature Review
Subjects:
Articles that
examined
outcomes of
Intervention:
Ethnographic case
study methods and
socio-cultural activity
theory were used to
examine multiple
perspectives concerning
school-based OT
collaborative
consultation
Lack of control
groups
Unrealistic
consultation visits by
Author/
Year
Study Objectives
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
school-based OT
collaborative
consultation
services, and
factors influencing
collaborative
consultation.
role and
responsibilities
of the OT, and
the therapist
must understand
school policies,
the curriculum
and the practice
of the individual
teacher.
OT
Terms utilized:
Children with
disabilities in
educational settings,
collaboration,
consultation, school
health-services,
occupational therapy,
and motor skills.
Outcome Measures:
Relationship between
school-based OT
collaborative
consultation and
outcomes for students
with disabilities.
Factors that influenced
collaboration between
educators and OTs
Teacher ratings and
stakeholder satisfaction
were considered
Implications for OT
Program Development:
Unclear definition of
consultation
Relevant only to
Canadian context
Societal Needs:
Dissatisfaction with wait
time for services and visit
frequency can possibly be
addressed with consultative
services.
Author/
Study Objectives
Year
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
Determine the
percentage of time
school-based
therapists spend using
direct, pull-out and
integrative
consultative models of
service delivery, to
explore the attitudes of
OTs toward
Level II
46-item questionnaire
distributed to OTs by
mail
Design:
Cohort Study
Subjects:
Consultative
models of
practice were
advantageous for
the teachers and
the students
Survey
Accountability
and outcome
development
Author/
Study Objectives
Level/Design/
Subjects
direct/pull-out and
integrative/
consultative services,
and identify variables
associated with
attitudes toward each.
Year
Selected randomly
on the basis of the
following criterion:
-Minimum of 1
year of experience
working as an OT
in a public or
private school
setting, by contract
or by direct
employment.
Intervention and
Outcome Measures
Results
evaluations were
not issues in
implementing
current models
of integrated
practice in
classrooms
OTs value direct
service delivery,
one-on-one
interactions with
students, and to
establish
relationships
with students.
Study Limitations
Implications for OT
Program Development:
No open-ended
questions for
justification
Societal Needs:
Ideally service delivery
models vary according to the
individualized needs of
students and teachers
Author/
Study Objectives
Year
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
Describe the
collaborative team
practices between
teachers and OTs in
one school district.
Explore relationships
between team
practices and student
IEP goals met
Level II
Intervention:
Design: Cohort
Study
A questionnaire was
provided to the teachers
containing items about
OT service delivery
practices for students
Subjects:
40 teachers of
Mean percentage
of IEP objectives
met per student
was 61%
Sensitivity to changes
in students skills
limited due to
reporting strategy
(Met or unmet)
Author/
Study Objectives
Year
Explore relationship
between team
practices and teacher
perceptions of OT
contributions to
student skill
development.
Level/Design/
Subjects
students, who
received OT
services
Intervention and
Outcome Measures
Rankings of
OT contribution to the
students skill
development on a 5point Likert scale
Outcome measures:
Four-part Teacher
Questionnaire about OT
with Special Education
Students.
Results
The respondents
written
comments
indicated that
collaborative
team practices
were frequently
conducted
informally and
within
immediate
school areas.
Successful
problem-solving
strategies for
students were
developed
through these
discussions. In
contrast, formal
team meetings
appeared to be
difficult to
implement for
many teachers
and therapists
Study Limitations
Implications for OT
Societal Needs:
Successful collaboration
among teachers and relatedservice personnel
is described as essential for
effective intervention to
occur in todays educational
environment
Author/
Study Objectives
Year
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
Reid, Chiu,
Sinclair,
Wehrmann, &
Naseer (2006).
Level III
Design:
Pretest/Posttest
Part 1
Subjects:
91 Students
Referral diagnosis
of fine motor delay,
fine motor deficit,
fine and gross
Intervention:
OTs who were all
trained to ensure the
Canadian Occupational
Performance Model
(COPM) and Teacher
Awareness Scale (TAS)
administered the
evaluations to students
according to
standardized protocol.
Outcome Measures:
-COPM: Primary
Frequently
identified
problems:
-Writing or
printing
-Organization
skills
-Desk Skills
7 statistically
significant
variables
Lack of a control
group
Data collection
limited to a single
organization limiting
Collaborative consultation
services are most effective in
conjunction with direct
services when working with
children with fine motor
deficits.
generalizability.
TAS measurement
tool only evaluated
for test-retest
reliability and no
other psychometric
Program Development:
OTs should ensure the
teachers have awareness and
understanding of the
students occupational
10
Author/
Study Objectives
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
perspectives including
teachers, service
funders, OTs, students
& their parents.
identified:
properties.
Year
Determine how
satisfied the teachers
of these studies are
regarding the OTSBC
service delivery
process.
-Client Feedback
Questionnaire (CFQ):
Measure how satisfied
the teachers, parents,
and caregivers were
with the OTSBC
services.
-COPM
Performance
Score
Societal Needs:
-TAS subscale
change score
-Teacher
Implementation
score
-CFQ Teacher
subscale score
-Pencil grip
recommended
to school
personnel
-Pencil grip
recommended
to parents
If intervention is not
provided early, children with
fine motor difficulties are at
risk of motor difficulties that
persist into adolescence and
can lead to the development
of secondary mental health
and educational issues
including poor social
competence, academic
problems, behavioral
problems, and low selfesteem.
11
Author/
Study Objectives
Year
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
-School Type
Design:
Qualitative Study
Part 2
Subjects:
52 participants
Intervention:
Supports the
OTSBC service
used in Part 1 of
study.
OTSBC is
beneficial to
students with
fine motor
OTSBC service
provided by a single
organization
12
Author/
Study Objectives
Year
influence outcomes of
OTSBC from multiple
perspectives including
teachers, service
funders, OTs, students
and their parents.
Level/Design/
Subjects
7 Community Care
Access Centres
(CCAC) case
managers, 10 OTs,
14 teachers, and 21
parents of the 91
students involved
in phase 1 of study
Intervention and
Outcome Measures
Results
debriefing session.
difficulties.
Outcome Measures:
Change in Skills
-written communication
Study Limitations
Implications for OT
Timing of study:
Torontos healthcare
system under policy
changes
Program Development:
During the initial contact, the
OT explains with the school
and family about the nature
of the consultative model.
Societal Needs: A
consultative service delivery
model can allow the OT to
provide services that benefit
more children with less
resources and better
outcomes.
Facilitators to change
-OT intervention
-team approach
-school environment
Challenges affecting
change
-characteristics of the
student
(social/emotional
13
Author/
Study Objectives
Year
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
issues)
Implications for OT
trained to effectively
intervene with both the social
and physical environments of
the students in addition to the
students themselves.
-school system
-service delivery
process
Suggestions for
improvement
-early identification of
fine motor difficulties
-More OT visits
-better communication
among team members
-addressing system
issues in healthcare
sector
-addressing issues in
education sector
Dunn (1990).
Level I
Intervention:
Design:
Randomized
Students were
randomly assigned to
either direct service
conditions, or
consultation conditions.
All children in
the study
achieved nearly
three-fourths of
their IEP goals.
14
Author/
Year
Study Objectives
Level/Design/
Subjects
Intervention and
Outcome Measures
Control Trial
Outcome Measures:
Subjects:
The Developmental
Programming for
Infants & Young
Children (DPIYC)
12 preschool, 2
kindergarten
students and their
teachers.
Results
Study Limitations
Implications for OT
Program Development:
Including the teacher in the
intervention planning, and
allowing them to be more
hands on, can make them feel
more positive about the
situation and be more willing
to consider new intervention
options.
Societal Needs:
The OT services provided
impact more that the
immediate child outcomes
and the therapist should
consider the others within the
same environment.
15
Author/
Year
Study Objectives
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
16
Author/
Study Objectives
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
Compare the
effectiveness of a
consultative model of
intervention with a
directindirect
intervention for
meeting goals of
preschool students
with mild motor
delays.
Level III
Intervention: OTs
provided consultation
to teams working with
11 children for 40
weeks. Another OT
provided direct-indirect
treatment to 9 other
children for 40 weeks.
Both models of
intervention
were found to
help students
meet their goal at
approximately
the rate
expected.
Year
Dreiling &
Bundy (2003).
Design: Single
group, pretest and
posttest, quasiexperimental
1 geographic area
used
Variability of
diagnoses
Subjects:
22 children
between 3 and 5
years of age
Outcome Measures:
The study measured
motor outcomes with
standardized motor skill
assessments
Peabody
Developmental Motor
Scales
Current IEP
requiring OT
Not receiving
private OT services
during study.
Learning
Accomplishment
Profile
Developmental Test of
Visual-Motor
Integration.
Consultation
group: met or
exceeded
expectations on
56% of goals
Directindirect
intervention
group met or
exceeded
expectations on
50% of goals.
Cognitive and
behavioral
development not
controlled
Program Development:
A consultative model
requires the same amount of
time or more that a direct
intervention requires to
initiate the service delivery
model. However, the amount
of time required will
decrease with program
maturation.
Societal Needs:
A consultation service
delivery model provides
more support for children
with disabilities within the
classroom and is more
17
Author/
Year
Study Objectives
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
18
Author/
Study Objectives
Year
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
Explore if children
with fine motor
difficulties receiving
school-based OT
consultation services
have improvement in
written
communication and
fine motor skills.
Level III
Intervention:
OTs provided
Design: Single
group, pretest and
posttest, quasiexperimental
Subjects:
23 students (19
boys and four girls)
completed the
study.
Intervention
included the following:
collaborative
identification of
target areas, assessment
of skills as well as the
development and
provision of
Significant
difference in
pretest to
posttest
measures on the
written
communication
sub-scale of the
VABS-C and on
the written work
subscale of the
SFA.
Significant
pretest to
posttest
difference was
found on the
using materials
subscale of the
SFA.
Unable to account
for amount of direct
services received
Program Development:
Taking a more holistic
approach that involves team
decision making with the
teacher may help to integrate
the recommendations
into the classroom and
19
Author/
Year
Study Objectives
Level/Design/
Subjects
Intervention and
Outcome Measures
consultation strategies
and recommendations
to teachers and parents.
Results
Study Limitations
Implications for OT
Societal Needs:
This study determined that a
combination of direct and
consultative model of therapy
may be the most beneficial
for children with fine motor
difficulties.
20
Author/
Year
Study Objectives
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
OT Students:
OT students should be aware
of a childs learning process
and what is least restrictive to
an individual because
children may not develop
new skills as easily as adults
within an environment with a
lot of contextual interference
such as in a classroom
setting.
21
Author/
Study Objectives
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
Level V
Results showed
that to establish
fluid service
delivery models,
therapists need
to:
Year
Case-Smith &
Holland
(2009).
Design: Case
Report
Subject:
4 year old girl
who has cerebral
palsy with spastic
quadriparesis.
Therapists provided
direct services and
consultation to the
teacher for feeding,
bathroom
independence,
communication, and
mobility.
-Plan together
with teachers so
the model
selected meets
the teachers
preferences
-Design flexible
scheduling
systems that
emphasize
inclusive
practice
-Maintain
precise records
about when and
how services are
provided.
Program Development:
It is important to consult with
the teacher to make sure the
model and interventions
being utilized meet the
teachers preference.
Societal Needs:
Interdisciplinary teams
should be utilized within a
collaborative service delivery
model to ensure all of the
childs needs are met.
22
Author/
Year
Study Objectives
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
23
Author/
Year
Study Objectives
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study Limitations
Implications for OT
24