PURPOSE: This study had the following aims to identify the current level of pull-out and push-in service provision by school-based occupational therapists (OTs) and to gather information about the facilitators of and barriers to using push-in service delivery within that school system.

BACKGROUND: In the past decade, there has been a push for students with Individualized Education Programs to be more included in the general education classroom with their nondisabled peers, with a similar argument for occupational therapy to also occur in the child’s classroom so that skills are learned in the context in which they will be used. Multiple years have passed since two studies showed that OTs provided more pull-out than push-in therapy. Neither of those studies examined what barriers to providing push-in services existed.

DESIGN: This study used a mixed-methods design.

PARTICIPANTS: OTs working in school district in a large Western metropolitan area.

METHOD: Participants filled out an anonymous online survey requesting information about their practice in the schools and their training. Those willing to be interviewed provided contact information and were interviewed over the telephone. Interview questions focused on how they made their decisions about service delivery models and their perceptions of what aided in providing push-in services and what hindered that kind of service.

ANALYSIS: Interviews were transcribed and then coded to develop themes in identifying potential facilitators and barriers to the implementation of push-in service delivery. Each interviewee was contacted for member checking to ensure an accurate reflection of the themes in the interview.

RESULTS: Forty-three OTs and 2 occupational therapy assistants (OTAs) completed the survey, indicating that services were provided 39% of the time in an occupational therapy area and 50% of the time within special or general education setting. Nine OTs and 1 OTA were interviewed.

In general, therapists were positively inclined toward providing push-in services, although they did not believe that it was best for the needs of every child. The themes that emerged were a sense of positivity from the therapists, the student’s needs, education and training, the school environment, relationships and attitudes, and caseload and workload. Each theme that emerged could be a facilitator or barrier depending on its presence or absence.

Facilitators included the therapist’s understanding how to implement push-in services and when the educational system backed the use of this delivery system. Barriers included lack of therapist training, lack of support in the school for push-in services, high caseloads, variable therapist schedules, and lack of consistent classroom schedules.

DISCUSSION: These data indicate that although therapists view push-in delivery as favorable for some occupational therapy services, barriers have limited its implementation as a primary model for school-based occupational therapists in Colorado. School districts will need to provide more support for this type of service, assist in the training of its teachers about the benefits of this service provision, and do a better job of managing caseloads and workloads to allow therapists to implement push-in services.

IMPACT STATEMENT: There will need to be significant elimination of barriers in the school setting before push-in services become the primary service delivery model in widespread use. Increased research into the benefits of push-in services is needed to give therapists strong evidence to argue for elimination of these barriers.