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Research Article
Issue Date: September/October 2016
Published Online: July 27, 2016
Updated: January 01, 2021
Social Participation in Schools: A Survey of Occupational Therapy Practitioners
Author Affiliations
  • Kelly Leigers, MS, OTR/L, is Assistant Professor, Eastern Kentucky University, Richmond; Kelly.Leigers@EKU.edu
  • Christine Myers, PhD, OTR/L, is Research Assistant Professor, University of Florida, Gainesville
  • Colleen Schneck, ScD, OTR/L, FAOTA, is Department Chair and Professor, Eastern Kentucky University, Richmond
Article Information
Professional Issues / Rehabilitation, Participation, and Disability / Professional Issues
Research Article   |   July 27, 2016
Social Participation in Schools: A Survey of Occupational Therapy Practitioners
American Journal of Occupational Therapy, July 2016, Vol. 70, 7005280010. https://doi.org/10.5014/ajot.2016.020768
American Journal of Occupational Therapy, July 2016, Vol. 70, 7005280010. https://doi.org/10.5014/ajot.2016.020768
Abstract

OBJECTIVE. We sought to identify strategies and practices that school-based occupational therapy practitioners use in addressing social participation, their perceptions of competence, and factors influencing their strategies and practices.

METHOD. Surveys were sent to 500 randomly selected members of the American Occupational Therapy Association’s Early Intervention and School Special Interest Section; 112 usable surveys were received from 36 states.

RESULTS. Respondents reported focusing on internal client factors when addressing social participation. Fewer than half (46.5%) indicated that they understood their role (mean [M] = 4.23, standard deviation [SD] = 1.22), and 57.1% desired greater understanding or ability (M = 4.64, SD = 1.29). Differences were found based on years of experience, service delivery model used, and services provided by diagnosis category.

CONCLUSION. School-based occupational therapy practitioners may need to expand their current practices in addressing student social participation. Findings may be used to develop interventions to address this area of practice.

Students with disabilities spend a large part of their day within the educational and social structure of public or private schools. Individual client factors as well as the physical and social environment influence their level of participation within the school context. Research clearly demonstrates that the level of participation in common school roles and activities for students with disabilities is limited compared with that of same-age peers (Coster et al., 2013; Raghavendra, Olsson, Sampson, McInerney, & Connell, 2012). Commonly identified accessibility barriers for students with disabilities are lack of environmental modifications, student’s physical condition, negative peer attitudes toward those with disabilities, constructed environmental barriers, nature of the activity, and timing or scheduling of the activity. A metasynthesis of 15 qualitative studies revealed that adult and peer understanding of individual abilities and needs, decisions about accommodations, and quality of services and policies most strongly influenced youths’ participation (Kramer, Olsen, Mermelstein, Balcells, & Liljenquist, 2012).
Social participation is an important component of the education process because it can support or hinder learning outcomes. Students have reported that forming positive relationships with peers and teachers improves their sense of safety and belonging and provides an atmosphere conducive to learning (Bourke & Burgman, 2010; McMaugh, 2011). Students with disabilities are more likely to have lower social standing (Estell et al., 2008) and report greater social isolation (Orsmond, Shattuck, Cooper, Sterzing, & Anderson, 2013) than same-age peers without disabilities. Students who are not generally accepted by a peer group demonstrate more internalizing and externalizing symptoms of psychological maladjustment (DiGennaro Reed, McIntyre, Dusek, & Quintero, 2011; Klima & Repetti, 2008). Sepanski and Fisher (2011)  found that 90% of school administrators believed that students’ behavioral and psychosocial skills were a better predictor of academic success and school readiness than mental abilities. Thus, addressing social participation of students is important to promote academic success within the classroom.
Much discussion in the literature has examined occupational therapy’s role in addressing social participation for students with autism (Case-Smith & Arbesman, 2008; Cosbey, Johnston, & Dunn, 2010; Kasari, Rotheram-Fuller, Locke, & Gulsrud, 2012; Kauffman & Kinnealey, 2015; Orsmond et al., 2013) because impairment in social communication and interactions is one of the core features of autism. However, relatively little in the occupational therapy literature describes how social participation needs of students diagnosed with other disabilities are addressed in school-based practice.
To address this discrepancy, the purposes of this study were to identify the strategies and practices that school-based occupational therapy practitioners use to address the occupation of social participation, describe perceived levels of competence in addressing social participation of students with disabilities, and explore factors (practitioner experience and type of employment) that may influence intervention strategies and service delivery models provided for students with primary disabilities other than autism. An understanding of how practitioners address social participation needs across all disability categories can provide a foundation for future research and interventions.
Method
Participants
The target population consisted of occupational therapy practitioners who were members of the American Occupational Therapy Association’s (AOTA’s) Early Intervention and School Special Interest Section and who identified “school system” as their work setting. Surveys were sent to 500 randomly selected practitioners from an AOTA mailing list. The response rate was 34.95%, with 5 surveys returned as undeliverable. Fifty-seven respondents did not meet the inclusion criteria because they reported that they were neither an occupational therapist nor an occupational therapy assistant who worked in school-based practice. Four surveys were removed because more than 50% of items were unanswered. The 112 usable surveys from 36 states were completed by 102 occupational therapists (91.1%) and 10 occupational therapy assistants (8.9%). The majority of participants (56.4%) held a master’s degree, followed by 31.8% with a bachelor’s degree. Participants primarily reported working directly through a public school district (51.4%), as a private contractor (20.2%), or through a private agency (14.7%).
Instrument
We designed the survey questions to collect information about demographics; frequency and approach in addressing social participation in evaluations, interventions, and discharge planning; self-perception of competence; and education and training in addressing social participation. Participants were asked to report on the frequency with which they addressed social participation for students in specific disability categories.
Survey questions were based on issues identified in the literature and the authors’ personal experience as practitioners; the survey was then reviewed by 10 people from diverse backgrounds in pediatrics, school-based practice, and research. Four were occupational therapists with 1, 11, 17, and 27 yr of practice experience, with the majority of time spent in pediatric and school-based practice; 1 was an occupational therapy assistant with more than 15 yr in school-based practice; 5 were faculty members with varying degrees of concentration in pediatrics and school-based practice; 1 was a special education instructor with 11 yr of practice; and 1 was a research analyst. Revisions in wording, formatting, and question order were made on the basis of their feedback.
The final version consisted of 111 items; 106 items used a 6-point Likert scale (1 = never or strongly disagree, 6 = always or strongly agree), and 5 were open response for which participants could respond to an “Other (please indicate)” prompt. The remaining 5 items collected information related to employment, experience, and education. Social participation was defined on the survey as “an intentional interaction involving two or more individuals centered around any mutually agreed upon activity.” This definition is supported by the Occupational Therapy Practice Framework: Domain and Process (3rd ed.; AOTA, 2014), which incorporates engaging with others and creating social interdependence.
Data Collection and Analysis
The study was approved by the authors’ institutional review board. Participants were informed of the study through a cover letter describing the purpose of the study and informing participants of the consent process. Included with the cover letter were the survey and a prestamped business reply envelope. A follow-up postcard was mailed 7 days after the initial mailing to recipients. The postcard thanked those who had returned the survey and provided a reminder to those who wished to participate but had not yet sent in the survey.
Data were collected between December 2014 and February 2015. IBM SPSS Statistics (Version 22; IBM Corporation, Armonk, NY) was used for data analysis. Descriptive statistics, frequencies, and percentages were determined for respondents’ demographic information. Mean and standard deviation were calculated for strategies and practices used by occupational therapy practitioners, their perceived level of competence, and their perceived level of involvement related to specific disability categories.
Independent sample t tests (two-tailed) were used to examine the relationship between experience (identified as “5 years or greater” and “less than 5 years”) and type of employment (identified as “full-time” and “part-time/PRN” [i.e., on an as-needed basis]) with intervention strategies and service delivery models used in addressing social participation of students with disabilities. The use of the 5-yr mark to delineate between experienced and nonexperienced practitioners is supported by research (Case-Smith, 1994; Mitchell & Unsworth, 2005). Statistical significance (p value) was set at .05; however, because of inflation of α caused by multiple t tests, a .005 level of significance was used to reduce the chance of a Type I error.
Results
Intervention Strategies, Service Delivery Models, and Perceptions
Table 1 presents data regarding common intervention strategies and service delivery models used by participants in addressing social participation in school-based practice. Participants also reported on their perceived level of competence (Table 2) and level of involvement related to student disability (Table 3).
Table 1.
Participants’ Use of Intervention Strategies and Service Delivery Models
Participants’ Use of Intervention Strategies and Service Delivery Models×
Strategy or ModelMSDn% Reporting 1 or 2 (Less Likely)a% Reporting 5 or 6 (More Likely)a
Develop interventions focusing on internal client factors4.171.3411010.944.6
Address attitudes and behaviors of peers in social environment3.221.4511133.320.7
Address attitudes and behaviors of adults in social environment3.571.3711122.526.1
Organize social groups for students with and without disabilities2.101.2811169.37.2
Facilitate enrollment in clubs and sports for students with disabilities2.311.1911057.23.6
Work on social skills needed for early childhood transitions4.171.4311012.848.2
Work on social skills needed for postschool transitions1.961.2810971.54.6
Adapt classroom-based activities for increased interaction between students with and without disabilities3.921.6110921.144.9
Adapt physical environment to facilitate greater social interaction among students with and without disabilities3.721.5511022.735.4
Advocate for changes in policy and procedures that promote social participation among students with and without disabilities2.751.6011154.920.7
Address social participation of students by working with
 The student with the disability4.641.331108.260.9
 Peers in the student’s general education classroom3.101.4411136.916.2
 Peers in the student’s special education classroom3.661.3511119.827.9
 Special education instructors4.251.351119.047.7
 General education instructors3.911.5311117.142.3
 School administrators2.771.4611149.513.5
 Paraprofessionals4.231.4311112.648.6
 Parents and caregivers3.581.3211121.621.6
 Guidance counselor2.651.5810952.314.7
 Speech–language pathologist3.971.3710913.837.6
 Physical therapist or physical therapy assistant3.191.4511132.420.7
 Adapted physical education instructor2.611.5010952.311.9
 Resource teachers (e.g., music, art, gym)2.991.5310740.218.7
 Support staff2.351.4811160.011.7
Address social participation of students with disabilities through
 Direct, pull-out model3.631.4011220.532.1
 Direct, classroom-integrated model3.731.2811217.027.7
 Group intervention3.801.3311216.133.0
 Services on behalf of students (IDEA)3.791.5511020.934.6
 Program supports2.521.3511255.49.9
 Response to Intervention (Tier I)2.381.4111161.211.7
 Response to Intervention (Tier II)2.291.3611264.410.7
 Response to Intervention (Tier III)2.301.4511265.212.5
 Cotreatment2.841.4011243.712.5
 Coteaching2.881.5711045.618.8
Table Footer NoteNote. IDEA = Individuals With Disabilities Education Improvement Act of 2004; M = mean; SD = standard deviation.
Note. IDEA = Individuals With Disabilities Education Improvement Act of 2004; M = mean; SD = standard deviation.×
Table Footer NoteaResponse using Likert scale ranging from 1 (never) to 6 (always).
Response using Likert scale ranging from 1 (never) to 6 (always).×
Table 1.
Participants’ Use of Intervention Strategies and Service Delivery Models
Participants’ Use of Intervention Strategies and Service Delivery Models×
Strategy or ModelMSDn% Reporting 1 or 2 (Less Likely)a% Reporting 5 or 6 (More Likely)a
Develop interventions focusing on internal client factors4.171.3411010.944.6
Address attitudes and behaviors of peers in social environment3.221.4511133.320.7
Address attitudes and behaviors of adults in social environment3.571.3711122.526.1
Organize social groups for students with and without disabilities2.101.2811169.37.2
Facilitate enrollment in clubs and sports for students with disabilities2.311.1911057.23.6
Work on social skills needed for early childhood transitions4.171.4311012.848.2
Work on social skills needed for postschool transitions1.961.2810971.54.6
Adapt classroom-based activities for increased interaction between students with and without disabilities3.921.6110921.144.9
Adapt physical environment to facilitate greater social interaction among students with and without disabilities3.721.5511022.735.4
Advocate for changes in policy and procedures that promote social participation among students with and without disabilities2.751.6011154.920.7
Address social participation of students by working with
 The student with the disability4.641.331108.260.9
 Peers in the student’s general education classroom3.101.4411136.916.2
 Peers in the student’s special education classroom3.661.3511119.827.9
 Special education instructors4.251.351119.047.7
 General education instructors3.911.5311117.142.3
 School administrators2.771.4611149.513.5
 Paraprofessionals4.231.4311112.648.6
 Parents and caregivers3.581.3211121.621.6
 Guidance counselor2.651.5810952.314.7
 Speech–language pathologist3.971.3710913.837.6
 Physical therapist or physical therapy assistant3.191.4511132.420.7
 Adapted physical education instructor2.611.5010952.311.9
 Resource teachers (e.g., music, art, gym)2.991.5310740.218.7
 Support staff2.351.4811160.011.7
Address social participation of students with disabilities through
 Direct, pull-out model3.631.4011220.532.1
 Direct, classroom-integrated model3.731.2811217.027.7
 Group intervention3.801.3311216.133.0
 Services on behalf of students (IDEA)3.791.5511020.934.6
 Program supports2.521.3511255.49.9
 Response to Intervention (Tier I)2.381.4111161.211.7
 Response to Intervention (Tier II)2.291.3611264.410.7
 Response to Intervention (Tier III)2.301.4511265.212.5
 Cotreatment2.841.4011243.712.5
 Coteaching2.881.5711045.618.8
Table Footer NoteNote. IDEA = Individuals With Disabilities Education Improvement Act of 2004; M = mean; SD = standard deviation.
Note. IDEA = Individuals With Disabilities Education Improvement Act of 2004; M = mean; SD = standard deviation.×
Table Footer NoteaResponse using Likert scale ranging from 1 (never) to 6 (always).
Response using Likert scale ranging from 1 (never) to 6 (always).×
×
Table 2.
Participants’ Perceived Level of Competence in Addressing Social Participation
Participants’ Perceived Level of Competence in Addressing Social Participation×
ItemMSDn% Reporting 1 or 2 (Disagree)a% Reporting 5 or 6 (Agree)a
I understand my role in addressing social participation.4.231.221129.846.5
I have experience in addressing social participation.3.961.3411213.434.0
I am competent in my ability to address social participation.3.961.2811214.336.6
I would like a greater understanding of how to address social participation.4.641.2911221.457.1
I have had training and education in addressing social participation of students with disabilities through
 College coursework (excluding fieldwork)2.941.4211239.214.3
 Level 1 fieldwork experiences2.321.3811261.67.2
 Level 2 fieldwork experiences2.631.5211252.714.3
 Professional courses3.401.4911127.027.9
 Mentorship2.871.5711242.919.7
 Independent reading of peer-reviewed sources3.781.4211218.734.8
 On-the-job training4.021.6611021.848.2
 Certification1.911.3811073.67.3
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
Table Footer NoteaResponse using Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree).
Response using Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree).×
Table 2.
Participants’ Perceived Level of Competence in Addressing Social Participation
Participants’ Perceived Level of Competence in Addressing Social Participation×
ItemMSDn% Reporting 1 or 2 (Disagree)a% Reporting 5 or 6 (Agree)a
I understand my role in addressing social participation.4.231.221129.846.5
I have experience in addressing social participation.3.961.3411213.434.0
I am competent in my ability to address social participation.3.961.2811214.336.6
I would like a greater understanding of how to address social participation.4.641.2911221.457.1
I have had training and education in addressing social participation of students with disabilities through
 College coursework (excluding fieldwork)2.941.4211239.214.3
 Level 1 fieldwork experiences2.321.3811261.67.2
 Level 2 fieldwork experiences2.631.5211252.714.3
 Professional courses3.401.4911127.027.9
 Mentorship2.871.5711242.919.7
 Independent reading of peer-reviewed sources3.781.4211218.734.8
 On-the-job training4.021.6611021.848.2
 Certification1.911.3811073.67.3
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
Table Footer NoteaResponse using Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree).
Response using Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree).×
×
Table 3.
Participants’ Perceived Level of Involvement in Addressing Social Participation, by Student Disability Category
Participants’ Perceived Level of Involvement in Addressing Social Participation, by Student Disability Category×
Disability CategoryFormal AssessmentaInformal AssessmentaInterventionaDischarge Planning and Recommendationa
MSDnMSDnMSDnMSDn
Deaf–blindness1.420.98773.111.89722.731.57662.081.2365
Deafness1.360.90733.041.92702.551.45641.971.1466
Developmental delay2.501.821114.471.571114.171.311092.991.65106
Emotional disturbance2.211.611054.181.631043.871.451022.881.57100
Hearing impairment1.641.25903.401.78903.141.45842.271.3884
Intellectual disability2.351.631104.251.501103.871.351082.851.55105
Multiple disabilities2.221.591084.231.531093.851.381082.741.45105
Orthopedic impairment2.041.481063.861.711053.471.551042.541.43100
Other health impairment2.141.581054.141.581073.691.421052.671.45101
Specific learning disability2.201.591064.151.551083.791.391072.731.44104
Speech–language impairment2.021.561013.861.731033.711.411022.571.4999
Traumatic brain injury2.041.56993.891.81943.471.68952.531.4994
Visual impairment or blindness1.941.45953.671.82943.211.61902.401.4489
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
Table Footer NoteaResponse using Likert scale ranging from 1 (never) to 6 (always).
Response using Likert scale ranging from 1 (never) to 6 (always).×
Table 3.
Participants’ Perceived Level of Involvement in Addressing Social Participation, by Student Disability Category
Participants’ Perceived Level of Involvement in Addressing Social Participation, by Student Disability Category×
Disability CategoryFormal AssessmentaInformal AssessmentaInterventionaDischarge Planning and Recommendationa
MSDnMSDnMSDnMSDn
Deaf–blindness1.420.98773.111.89722.731.57662.081.2365
Deafness1.360.90733.041.92702.551.45641.971.1466
Developmental delay2.501.821114.471.571114.171.311092.991.65106
Emotional disturbance2.211.611054.181.631043.871.451022.881.57100
Hearing impairment1.641.25903.401.78903.141.45842.271.3884
Intellectual disability2.351.631104.251.501103.871.351082.851.55105
Multiple disabilities2.221.591084.231.531093.851.381082.741.45105
Orthopedic impairment2.041.481063.861.711053.471.551042.541.43100
Other health impairment2.141.581054.141.581073.691.421052.671.45101
Specific learning disability2.201.591064.151.551083.791.391072.731.44104
Speech–language impairment2.021.561013.861.731033.711.411022.571.4999
Traumatic brain injury2.041.56993.891.81943.471.68952.531.4994
Visual impairment or blindness1.941.45953.671.82943.211.61902.401.4489
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
Table Footer NoteaResponse using Likert scale ranging from 1 (never) to 6 (always).
Response using Likert scale ranging from 1 (never) to 6 (always).×
×
Some participants used the open response questions. Under intervention strategies, 1 participant indicated an item not listed: addressing attitudes and behaviors of volunteer caregivers in community roles (e.g., faith communities, summer camp programs, medical professionals). Under the open response for “individuals with whom you work,” 1 participant indicated working with social workers; however, 3 others added comments in the survey margins indicating that they also worked with social workers. Concerning service delivery models, 2 participants indicated an item not listed: addressing social participation through (1) supervision of occupational therapy assistants and (2) pulling students with and without disabilities out of the classroom for small group interactions.
Experience and Type of Employment
Differences in intervention strategies (10 items) and types of service delivery model (10 items) based on experience and type of employment were calculated. Participants with ≥5 yr of practice experience adapted activities for increased involvement of students with disabilities in classroom-based activities with peers (p = .003) and provided services on behalf of students (p < .001) more than those with <5 yr of experience. Participants with ≥5 yr of experience adapted activities for increased involvement in classroom-based activities (p < .001), adapted the physical environment to allow for greater social interaction (p = .004), and advocated for changes in policy and procedures to promote social participation (p = .001) more than those with <5 yr of experience.
Participants with ≥5 yr of experience provided services on behalf of students (p < .001) and Response to Intervention (RtI) Tier 1 (classroom-based) services (p = .004) more than those with <5 yr of experience. Services on behalf of the student was defined as services conducted for the benefit of a student but that occurred outside direct interventions (e.g., collaboration and consultation with other professionals). RtI was defined as early identification and support of students not currently served by special education. An example of Tier 1 classroom-based intervention under RtI is a classroom-based disability awareness program to promote positive attitudes and behaviors toward those with disabilities. Participants with ≥5 yr of experience used services on behalf of students (p = .005) and RtI Tier 2 (small group) service delivery models (p = .002) more than those with <5 yr of experience. No statistically significant correlations were found with type of employment (full-time vs. part-time/PRN), intervention strategy, or service delivery model.
Discussion
The results of this study indicate possible reasons for concern regarding current practices in addressing social participation of students with disabilities in school-based settings. Participants’ perceived competence was relatively low; fewer than half (46.5%) understood their role in addressing students’ social participation needs. Sensory or motor impairments have been identified by both occupational therapists (Spencer, Turkett, Vaughan, & Koenig, 2006) and teachers (Huang, Peyton, Hoffman, & Pascua, 2011) as the primary area addressed by occupational therapy practitioners, and occupational therapy practitioners are often misrepresented as “handwriting teachers” (Cahill & Lopez-Reyna, 2013). Referrals for occupational therapy services are most often in the areas of handwriting, sensory processing, self-care, and general fine motor concerns (Argabrite-Grove, 2002), indicating a limited understanding of the occupational therapy role.
Only 36.6% of the participants in this study believed that their understanding, experience, and training gave them the skills necessary to provide social participation evaluations and interventions. Few practitioners indicated that their preservice education such as college coursework (14.3%), Level I fieldwork (7.2%), or Level II fieldwork (14.3%) addressed social participation. This finding is consistent with an earlier finding that entry-level practitioners often do not feel ready for school-based practice (Brandenburger-Shasby, 2005). Practitioners in this study most frequently reported gaining knowledge through independent reading of professional journals (34.8%) and on-the-job training (48.2%). Such training may be insufficient, though, if it lacks characteristics of professional development necessary for increasing competence or effecting practice change (Laverdure, 2014). Recent changes to the occupational therapy program accreditation process, however, require that “at least one fieldwork experience . . . has as its focus psychological and social factors that influence engagement in occupation” (AOTA, 2012, Standard C.1.7). This change may result in occupational therapy students witnessing psychosocial-based evaluations and interventions at an increased rate.
In addition to education, experience also influenced which service delivery models participants used, particularly in conducting services on behalf of students and using RtI in classrooms and small groups. These forms of service delivery require collaboration with other professionals. Fewer than half of participants, however, indicated they would be likely to engage with special education teachers (47.7%), general education teachers (42.3%), or paraprofessionals (48.6%) when addressing social participation. One participant indicated that she did not address social participation because she felt her role was to support the goals written by the special education teacher; this response suggests a lack of collaboration during the development of student goals.
The parent–therapist relationship is also important to success (Benson, Elkin, Wechsler, & Byrd, 2015) yet, alarmingly, only 21.6% of participants indicated working with parents or caregivers. Parents have indicated interest in being more involved in collaboration; they have also expressed frustration at the lack of focus on social participation and social skill development by occupational therapists (Benson et al., 2015). Although occupational therapists have tended to agree that collaboration is best practice, they have not often used this approach (Kennedy & Stewart, 2012).
Participants were most likely to indicate working with students with a disability (60.9%), but few were likely to work with those who have the most contact with these students—peers in general education (16.2%) and special education (27.9%). Students with high-incidence disabilities who experience positive peer relationships are less likely to experience emotional and behavioral problems (Murray & Greenberg, 2006). However, lack of awareness may persist about these benefits of social participation. One participant stated she would address social participation more but that the “demands and time constraints warrant more focus on the fine motor skills, bilateral coordination, general gross motor, and sensory processing difficulties.”
Another barrier may be that practitioners feel confined to traditional pull-out service delivery models that impede working with the peers of students with disabilities. Practitioners may need administrative support in incorporating best practices of working in the natural context and incorporating peers without disabilities into classroom-based interventions. As practitioners follow the least restrictive environment mandate (Individuals With Disabilities Education Improvement Act of 2004; Pub. L. 108–446), a push into the classroom will be seen, enabling practitioners to more effectively address the social context through classroomwide strategies as part of RtI practices. Peers, who form a part of this social context, have reported feelings of fear, lack of preparation, and alienation in socializing with students with disabilities (Whitehurst & Howells, 2006). In the classroom, practitioners could implement programs that provide practical knowledge regarding what it feels like to have a disability and what peers can do to increase interaction (Leigers & Myers, 2015).
In this study, practitioner experience also influenced the types of intervention strategy used. Inexperienced practitioners were less likely to adapt activities or the physical environment in preparation for group activities with peers. Occupational therapists have reported that groups promote social interactions between participants (Camden, Tétreault, & Swaine, 2012) and allow practitioners to evaluate abilities in a social setting, thus serving as a preferred method in addressing social participation; however, the therapists found that designing groups required substantial effort to implement (Camden et al., 2012).
Inexperienced participants were also less likely to advocate for changes in policy and procedures that would promote participation between students with and without disabilities. The facilitation of social participation, done in a manner that promotes equity and co-occupation, can be a mechanism for societal change. Through social participation, the social barriers of stigma and indignity experienced by people with disabilities can be broken down, furthering their engagement in chosen occupations (Law, 2002). However, only 13.5% of participants in this study indicated they were likely to work with school administrators. Collaborating with school administration is also often needed to facilitate participation in nonacademic events; participants reported low levels of involvement in organizing social groups (7.2%) and facilitating enrollment in clubs and sports for students with disabilities (3.6%).
Another concern is that practitioners may not be focusing on social participation during transitions. Transitions can be critical times for students with disabilities as they enter new social and physical contexts, yet fewer than half (48.2%) of practitioners reported working on skills needed for early childhood transitions (e.g., sharing). This finding suggests a lack of practitioner involvement at a critical time in early school years (Myers, 2008). Alarmingly, only 4.6% of participants reported working with students with disabilities on skills needed for postschool transitions (e.g., interview skills). Despite positive beliefs regarding the role of occupational therapy in secondary transition planning, involvement by occupational theray practitioners as students plan and prepare for adult roles is generally low (Mankey, 2011). When occupational therapists are involved, their focus tends to be on technology, task or environmental modifications, and individualized education and transition planning (Spencer, Emery, & Schneck, 2003). Michaels and Orentlicher (2004)  found that ensuring that students develop valued roles and places in community life as well as personal relationships and friendships were important principles in the provision of person-centered transition services.
Participants also favored particular disability categories when looking at social participation. For example, research shows that students with sensory impairments demonstrate lower levels of participation, report social interactions that negatively affect self-concept, and have difficulty making friends (Engel-Yeger & Hamed-Daher, 2013; Punch & Hyde, 2005; Wolters, Knoors, Cillessen, & Verhoeven, 2014). However, participants who reported working with students who are deaf, hearing impaired, or deaf–blind or who have visual impairments or blindness were less likely to address these students’ social participation needs than those of students in other disability categories. Participants were more likely to identify addressing the social participation needs of students with developmental delay, intellectual disability, and multiple disabilities than the needs of students with other disability categories.
Research on common practices in working with students with autism, although not specifically addressed in this study, has shown similar findings. Ashburner, Rodger, Ziviani, and Jones (2014)  found that most occupational therapists (82%) indicated that they very rarely or never assessed social participation of students with autism through a formal assessment tool but instead relied on informal methods (e.g., interview, observation). However, they found that 57% of therapists indicated that their main source of evidence was from presentations at workshops and conferences, and 52% identified social skills and relationship development as a frequent focus of identified goals. This finding may suggest that information and education play a part in clarifying roles and creating an understanding of how a specific disability influences social participation.
Limitations
The survey was developed specifically for this study and did not undergo procedures to establish psychometrics. Results of the open response items indicate that social workers should have been included in the list of professionals with whom practitioners may work. The target population, members of AOTA’s Early Intervention and School Special Interest Section, may not be wholly representative of all occupational therapy practitioners working in school-based practice. Practitioners who are part of a national organization may be more likely to engage in training and education to advance their knowledge in particular areas of practice, may engage in different service delivery models, and may overall feel more competent in their abilities because of these experiences.
Furthermore, although the demographic portion of the survey attempted to account for differences in employment, education level, and years of practice, the survey was unable to distinguish differences in school-based practice that are influenced by policies and practices at the state and district levels. Finally, regarding disability-specific survey items, participants may have had difficulty separating out their involvement with students in certain disability categories from involvement with all students on their caseload.
Future Research
We suggest that a more fully tested instrument be created and used to measure how practitioners are meeting the social participation needs of students with disabilities and whether current education and training are sufficient in preparing practitioners to meet this need. Attempts to survey all practitioners through a nationally representative sample, not just those who are members of AOTA’s Early Intervention and School Special Interest Section, would be beneficial. Furthermore, because practitioners reported using informal assessments more frequently than formal assessments, research is needed to determine whether current formal assessments are meeting practitioners’ needs in evaluating students’ social participation across all disability categories. The development of a tool assessing social participation may be needed. Finally, a look at practitioner characteristics and practice factors that are more likely to lead to advocacy and collaboration in meeting the social participation needs of students with disabilities would be beneficial.
Implications for Occupational Therapy Practice
Occupational therapy practitioners in school systems are in an ideal position to address social participation of students with disabilities. The occupational therapy scope of practice includes increasing awareness of occupational justice and supporting the full participation of all people, regardless of ability level, “in the full range of meaningful and enriching occupations afforded to others, including opportunities for social inclusion” (Townsend & Wilcock, as quoted in AOTA, 2014, p. S43). Steps need to be taken to strengthen occupational therapy’s role and further support the engagement of students in their learning environments. Therefore, occupational therapy practitioners should
  • Educate people on their team and in the school community about the valued role of occupational therapy in school-based mental health,

  • Implement best practice in working with people within the social context of students with disabilities (e.g., teachers, support staff, peers) to facilitate their social participation,

  • Collaborate with administrators in supporting schoolwide initiatives and programs that support students of all abilities and advocate for changes in policy and procedures, and

  • Assess social participation needs and provide appropriate intervention as needed (e.g., during transitions, in and out of the classroom, by adapting physical and social contexts) regardless of the student’s disability label.

Conclusion
The strategies, practices, and perceptions of school-based occupational therapy practitioners regarding social participation for students with disabilities not categorized as an autism spectrum disorder demonstrate much variability. Occupational therapy practitioners in school-based practice should reflect on their level of involvement in addressing social participation. Many people in the school community may not understand the role of occupational therapy in addressing the social participation of students with disabilities; educating them about occupational therapy’s scope of practice may be required. Practitioners may need to use a wider array of intervention strategies and service delivery models to best meet the needs of these students.
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Table 1.
Participants’ Use of Intervention Strategies and Service Delivery Models
Participants’ Use of Intervention Strategies and Service Delivery Models×
Strategy or ModelMSDn% Reporting 1 or 2 (Less Likely)a% Reporting 5 or 6 (More Likely)a
Develop interventions focusing on internal client factors4.171.3411010.944.6
Address attitudes and behaviors of peers in social environment3.221.4511133.320.7
Address attitudes and behaviors of adults in social environment3.571.3711122.526.1
Organize social groups for students with and without disabilities2.101.2811169.37.2
Facilitate enrollment in clubs and sports for students with disabilities2.311.1911057.23.6
Work on social skills needed for early childhood transitions4.171.4311012.848.2
Work on social skills needed for postschool transitions1.961.2810971.54.6
Adapt classroom-based activities for increased interaction between students with and without disabilities3.921.6110921.144.9
Adapt physical environment to facilitate greater social interaction among students with and without disabilities3.721.5511022.735.4
Advocate for changes in policy and procedures that promote social participation among students with and without disabilities2.751.6011154.920.7
Address social participation of students by working with
 The student with the disability4.641.331108.260.9
 Peers in the student’s general education classroom3.101.4411136.916.2
 Peers in the student’s special education classroom3.661.3511119.827.9
 Special education instructors4.251.351119.047.7
 General education instructors3.911.5311117.142.3
 School administrators2.771.4611149.513.5
 Paraprofessionals4.231.4311112.648.6
 Parents and caregivers3.581.3211121.621.6
 Guidance counselor2.651.5810952.314.7
 Speech–language pathologist3.971.3710913.837.6
 Physical therapist or physical therapy assistant3.191.4511132.420.7
 Adapted physical education instructor2.611.5010952.311.9
 Resource teachers (e.g., music, art, gym)2.991.5310740.218.7
 Support staff2.351.4811160.011.7
Address social participation of students with disabilities through
 Direct, pull-out model3.631.4011220.532.1
 Direct, classroom-integrated model3.731.2811217.027.7
 Group intervention3.801.3311216.133.0
 Services on behalf of students (IDEA)3.791.5511020.934.6
 Program supports2.521.3511255.49.9
 Response to Intervention (Tier I)2.381.4111161.211.7
 Response to Intervention (Tier II)2.291.3611264.410.7
 Response to Intervention (Tier III)2.301.4511265.212.5
 Cotreatment2.841.4011243.712.5
 Coteaching2.881.5711045.618.8
Table Footer NoteNote. IDEA = Individuals With Disabilities Education Improvement Act of 2004; M = mean; SD = standard deviation.
Note. IDEA = Individuals With Disabilities Education Improvement Act of 2004; M = mean; SD = standard deviation.×
Table Footer NoteaResponse using Likert scale ranging from 1 (never) to 6 (always).
Response using Likert scale ranging from 1 (never) to 6 (always).×
Table 1.
Participants’ Use of Intervention Strategies and Service Delivery Models
Participants’ Use of Intervention Strategies and Service Delivery Models×
Strategy or ModelMSDn% Reporting 1 or 2 (Less Likely)a% Reporting 5 or 6 (More Likely)a
Develop interventions focusing on internal client factors4.171.3411010.944.6
Address attitudes and behaviors of peers in social environment3.221.4511133.320.7
Address attitudes and behaviors of adults in social environment3.571.3711122.526.1
Organize social groups for students with and without disabilities2.101.2811169.37.2
Facilitate enrollment in clubs and sports for students with disabilities2.311.1911057.23.6
Work on social skills needed for early childhood transitions4.171.4311012.848.2
Work on social skills needed for postschool transitions1.961.2810971.54.6
Adapt classroom-based activities for increased interaction between students with and without disabilities3.921.6110921.144.9
Adapt physical environment to facilitate greater social interaction among students with and without disabilities3.721.5511022.735.4
Advocate for changes in policy and procedures that promote social participation among students with and without disabilities2.751.6011154.920.7
Address social participation of students by working with
 The student with the disability4.641.331108.260.9
 Peers in the student’s general education classroom3.101.4411136.916.2
 Peers in the student’s special education classroom3.661.3511119.827.9
 Special education instructors4.251.351119.047.7
 General education instructors3.911.5311117.142.3
 School administrators2.771.4611149.513.5
 Paraprofessionals4.231.4311112.648.6
 Parents and caregivers3.581.3211121.621.6
 Guidance counselor2.651.5810952.314.7
 Speech–language pathologist3.971.3710913.837.6
 Physical therapist or physical therapy assistant3.191.4511132.420.7
 Adapted physical education instructor2.611.5010952.311.9
 Resource teachers (e.g., music, art, gym)2.991.5310740.218.7
 Support staff2.351.4811160.011.7
Address social participation of students with disabilities through
 Direct, pull-out model3.631.4011220.532.1
 Direct, classroom-integrated model3.731.2811217.027.7
 Group intervention3.801.3311216.133.0
 Services on behalf of students (IDEA)3.791.5511020.934.6
 Program supports2.521.3511255.49.9
 Response to Intervention (Tier I)2.381.4111161.211.7
 Response to Intervention (Tier II)2.291.3611264.410.7
 Response to Intervention (Tier III)2.301.4511265.212.5
 Cotreatment2.841.4011243.712.5
 Coteaching2.881.5711045.618.8
Table Footer NoteNote. IDEA = Individuals With Disabilities Education Improvement Act of 2004; M = mean; SD = standard deviation.
Note. IDEA = Individuals With Disabilities Education Improvement Act of 2004; M = mean; SD = standard deviation.×
Table Footer NoteaResponse using Likert scale ranging from 1 (never) to 6 (always).
Response using Likert scale ranging from 1 (never) to 6 (always).×
×
Table 2.
Participants’ Perceived Level of Competence in Addressing Social Participation
Participants’ Perceived Level of Competence in Addressing Social Participation×
ItemMSDn% Reporting 1 or 2 (Disagree)a% Reporting 5 or 6 (Agree)a
I understand my role in addressing social participation.4.231.221129.846.5
I have experience in addressing social participation.3.961.3411213.434.0
I am competent in my ability to address social participation.3.961.2811214.336.6
I would like a greater understanding of how to address social participation.4.641.2911221.457.1
I have had training and education in addressing social participation of students with disabilities through
 College coursework (excluding fieldwork)2.941.4211239.214.3
 Level 1 fieldwork experiences2.321.3811261.67.2
 Level 2 fieldwork experiences2.631.5211252.714.3
 Professional courses3.401.4911127.027.9
 Mentorship2.871.5711242.919.7
 Independent reading of peer-reviewed sources3.781.4211218.734.8
 On-the-job training4.021.6611021.848.2
 Certification1.911.3811073.67.3
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
Table Footer NoteaResponse using Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree).
Response using Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree).×
Table 2.
Participants’ Perceived Level of Competence in Addressing Social Participation
Participants’ Perceived Level of Competence in Addressing Social Participation×
ItemMSDn% Reporting 1 or 2 (Disagree)a% Reporting 5 or 6 (Agree)a
I understand my role in addressing social participation.4.231.221129.846.5
I have experience in addressing social participation.3.961.3411213.434.0
I am competent in my ability to address social participation.3.961.2811214.336.6
I would like a greater understanding of how to address social participation.4.641.2911221.457.1
I have had training and education in addressing social participation of students with disabilities through
 College coursework (excluding fieldwork)2.941.4211239.214.3
 Level 1 fieldwork experiences2.321.3811261.67.2
 Level 2 fieldwork experiences2.631.5211252.714.3
 Professional courses3.401.4911127.027.9
 Mentorship2.871.5711242.919.7
 Independent reading of peer-reviewed sources3.781.4211218.734.8
 On-the-job training4.021.6611021.848.2
 Certification1.911.3811073.67.3
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
Table Footer NoteaResponse using Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree).
Response using Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree).×
×
Table 3.
Participants’ Perceived Level of Involvement in Addressing Social Participation, by Student Disability Category
Participants’ Perceived Level of Involvement in Addressing Social Participation, by Student Disability Category×
Disability CategoryFormal AssessmentaInformal AssessmentaInterventionaDischarge Planning and Recommendationa
MSDnMSDnMSDnMSDn
Deaf–blindness1.420.98773.111.89722.731.57662.081.2365
Deafness1.360.90733.041.92702.551.45641.971.1466
Developmental delay2.501.821114.471.571114.171.311092.991.65106
Emotional disturbance2.211.611054.181.631043.871.451022.881.57100
Hearing impairment1.641.25903.401.78903.141.45842.271.3884
Intellectual disability2.351.631104.251.501103.871.351082.851.55105
Multiple disabilities2.221.591084.231.531093.851.381082.741.45105
Orthopedic impairment2.041.481063.861.711053.471.551042.541.43100
Other health impairment2.141.581054.141.581073.691.421052.671.45101
Specific learning disability2.201.591064.151.551083.791.391072.731.44104
Speech–language impairment2.021.561013.861.731033.711.411022.571.4999
Traumatic brain injury2.041.56993.891.81943.471.68952.531.4994
Visual impairment or blindness1.941.45953.671.82943.211.61902.401.4489
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
Table Footer NoteaResponse using Likert scale ranging from 1 (never) to 6 (always).
Response using Likert scale ranging from 1 (never) to 6 (always).×
Table 3.
Participants’ Perceived Level of Involvement in Addressing Social Participation, by Student Disability Category
Participants’ Perceived Level of Involvement in Addressing Social Participation, by Student Disability Category×
Disability CategoryFormal AssessmentaInformal AssessmentaInterventionaDischarge Planning and Recommendationa
MSDnMSDnMSDnMSDn
Deaf–blindness1.420.98773.111.89722.731.57662.081.2365
Deafness1.360.90733.041.92702.551.45641.971.1466
Developmental delay2.501.821114.471.571114.171.311092.991.65106
Emotional disturbance2.211.611054.181.631043.871.451022.881.57100
Hearing impairment1.641.25903.401.78903.141.45842.271.3884
Intellectual disability2.351.631104.251.501103.871.351082.851.55105
Multiple disabilities2.221.591084.231.531093.851.381082.741.45105
Orthopedic impairment2.041.481063.861.711053.471.551042.541.43100
Other health impairment2.141.581054.141.581073.691.421052.671.45101
Specific learning disability2.201.591064.151.551083.791.391072.731.44104
Speech–language impairment2.021.561013.861.731033.711.411022.571.4999
Traumatic brain injury2.041.56993.891.81943.471.68952.531.4994
Visual impairment or blindness1.941.45953.671.82943.211.61902.401.4489
Table Footer NoteNote. M = mean; SD = standard deviation.
Note. M = mean; SD = standard deviation.×
Table Footer NoteaResponse using Likert scale ranging from 1 (never) to 6 (always).
Response using Likert scale ranging from 1 (never) to 6 (always).×
×