Earn .

1 AOTA CEU
(one contact hour and
1.25 NBCOT PDU).
See page CE-7 for details.

Providing Collaborative and Contextual

Service in School Contexts and Environments
Patricia Laverdure, OTD, OTR/L, BCP 2. Identify the influences, affordances, and barriers to providing
Virginia Commonwealth University best practice in occupational therapy in school settings
Richmond, VA 3. Recognize competency domains and models of collaboration
that build team decision making and promote innovation in
Joanna Cosbey, PhD, OTR/L practice
University of New Mexico 4. Identify tools to optimize collaborative decision making and
Albuquerque, NM design contextual practice

Heather Gaylord, DSc, OTR/L, BCP, SCSS INTRODUCTION

Clark County School District The distinct value of occupational therapy lies in its focus
Las Vegas, NV on improving “health and quality of life through facilitating
participation and engagement in occupations, the meaningful,
Bridgette LeCompte, MS, OTR/L necessary, and familiar activities of everyday life” (American
Williamsburg-James City County Public Schools Occupational Therapy Association [AOTA], 2016b, p. 1). A
Williamsburg, VA practice that focuses on supporting a child’s participation
through engagement in meaningful occupation reflects our
This CE article was developed in collaboration with AOTA’s Early profession’s domain and core values (AOTA, 2014a). School-
Intervention & School Special Interest Section. based occupational therapy practitioners enhance student
participation by embracing a lifespan approach to promoting
ABSTRACT development across domains of function; modifying tasks and
Quality, reliability, and outcome are essential considerations environments; and providing service during naturally occur-
in occupational therapy service delivery. Although educational ring activity in naturally occurring locations (Frolek Clark &
legislative requirements do not require using specific occupa- Chandler, 2014). Handley-More, Wall, Orentlicher, and Hol-
tional therapy interventions, they have impacted how school lenbeck (2013) suggested that best practice in school settings
teams work with students, families, and one other. Shifting can be achieved by:
occupational therapy services to natural learning contexts l Gathering information across the environments in which
and environments and engaging actively in collaboration with students engage
educational partners has resulted in increased active student l Making decisions by collaborating with all relevant
participation and learning; greater opportunity for collaborative, stakeholders
meaningful decision making; increased capacity and satisfaction l Using evidence to conduct evaluations and develop goals and
of those working with children with disabilities; and increased intervention plans that are “framed in and measure child
perception of the value of occupational therapy services. Despite participation in context” (p. 1) and prepare students for edu-
emerging evidence of the effectiveness of collaborative and cational, vocational, and independent living opportunities
contextual occupational therapy practice in school settings, it after graduation
is a complex undertaking requiring understanding of influenc- l Providing services within the context of the students’ rou-
ing regulatory statutes and school policies as well as the role tines and activities
of occupational therapy in supporting the curriculum expec- l Modifying contexts and environments to support active
tations and classroom practices. Building understanding of engagement, emotional well-being, and social competence.
contextual and collaborative practice; identifying the influences,
affordances, and barriers; and establishing partnerships with Designing and delivering services collaboratively in a stu-
interdisciplinary team members is essential to providing best dent’s natural contexts and environment can take many forms,
occupational therapy practice in schools. depending on the student’s needs, parent and teacher concerns,
and the school’s and the school district’s culture and policies.
LEARNING OBJECTIVES Practitioners who work with teachers to adapt activities and
After reading this article, you should be able to: modify environments to enhance a student’s participation in
1. Define collaborative and contextual practice in school meaningful roles and routines; practitioners who help students
settings identify their personal interests and exercise their rights to

AUGUST 2017 l OT PRACTICE, 22(15) ARTICLE CODE CEA0817 CE-1

 Continuing Education Article
CE Article, exam, and certificate are also available ONLINE. Register at http://www.aota.org/cea or call toll-free 877-404-AOTA (2682).

make choices and decisions (Giovacco-Johnson, 2009); and Villeneuve (2009) found that although collaborative practice
practitioners who balance evidence and the students’ inter- varies significantly between occupational therapy practitioners
ests in designing interventions that enable students to engage and the many interdisciplinary teams with whom they interact,
actively and authentically in occupations of meaning (Frolek it is often characterized by:
Clark & Chandler, 2014) are all contemporary collaborative l Focusing on identifying levels of performance, establishing
contextual service providers who are using best practices in the and reviewing goals, and discussing skill development in the
school setting. Silverman (2011) stated, “Occupational [ther- areas of fine motor and written production, self-care, gross
apy practitioners], with their unique body of knowledge and motor skills, and postural control and regulatory/behavioral
practice domain, can be instrumental in designing and imple- management
menting ways to differentiate the learning process to support l Providing education, making programmatic recommenda-
learning” (p. 105). As occupational therapy practitioners provide tions, and designing environmental/task modifications.
their services in the student’s naturally occurring context, they
model the very activities and instructional strategies teaching Additionally, Villeneuve found:
staff can effectively integrate into the curriculum and classroom l Positive outcomes are impeded by occupational therapy
activities benefitting all students (Laverdure, Paulsen, Rumery, practitioners who assume an expert role in the collaboration
& Strunk, 2016). process.
l Negative outcomes are related to inadequate time; the itiner-
Core Competencies for Collaborative and Contextual Practice ant nature of occupational therapy practitioners; and teacher
Investing in collaborative relationships when providing school- understanding of the roles, responsibilities, and impact of
based occupational therapy contributes to many important therapy services and providers.
outcomes (Bayona, McDougall, Tucker, Nichols, & Mandich,
2006; Case-Smith & Rogers, 2005; Reid, Chiu, Sinclair, Weh- Collaborative discussions support evaluation findings and
rmann, & Naseer, 2006; Wehrmann, Chiu, Reid, & Sinclaii, help team members refine approaches, but they are not effec-
2006). tive in creating and planning innovative solutions to complex
These include: problems.
l Developing innovative teaching and learning supports, strat- Effective collaborative practice requires that all members of
egies, and technologies the interdisciplinary team commit time to collaboration and
l Identifying and addressing affordances and barriers in phys- understand special education regulation, school board policy,
ical, knowledge, skill, behavior, and attitudinal contextual curriculum and classroom practices, and the roles and responsi-
characteristics that influence a student’s participation in bilities of each member (Villeneuve, 2009; Villeneuve & Shulha,
school 2012). Effective collaboration occurs when team members
l Building capacity in caregivers, teachers, and administrators focus on discussing the expected outcomes of students within
l Developing student skills necessary to fulfill roles, partici- a specific educational context, defining the affordances and
pate effectively in routines, and engage actively in meaning- barriers to outcome achievement, and sharing innovative ways
ful occupations.

Achieving these outcomes depends on the occupational

therapy practitioner’s competencies in working collaboratively
with stakeholders within a complex organizational system.
When occupational therapy practitioners work in the classroom
setting, sharing their knowledge through modeling and demon-
stration and participating in program planning and problem
solving, teachers report increased satisfaction and understand-
ing of students’ needs (Fairbairn and Davidson, 1993), as well as
increased knowledge of their roles and responsibilities (Case-
Smith & Cable, 1996).
Villeneuve (2009) suggested that the relationship between
educators and occupational therapists is collaborative when it
depends on shared expertise. Within this collaborative tran-
sitional interchange, individuals from diverse intervention
perspectives can effectively identify strengths and needs and
establish individualized solutions to address challenges (Gutkin,
2002). Figure 1: Collaborative Practice Framework

CE-2 ARTICLE CODE CEA0817 AUGUST l OT PRACTICE, 22(15)

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.

to instruct and provide intervention to meet the expectations with interdisciplinary team members. The key purposes of the
(Fairbairn & Davidson, 1993). CPF are to identify and prioritize occupational engagement
How then do occupational therapy practitioners carve challenges; design creative, innovative, and collaborative inter-
time to collaborate with team members to identify innovative vention plans and data collection methods; monitor the fidelity
solutions to students’ unique and complex problems? What does of interventions; and flexibly and quickly respond to progress
collaborative practice look like? Spencer, Turkett, Vaughan, & trends.
Koenig (2006) suggested that interdisciplinary team members As previously noted, interdisciplinary teams generally spend
must develop skills in communication, interpersonal relation- time identifying the issues and establishing goals but don’t
ships, and building partnerships. Building capacity in these skill effectively use collaborative practice to analyze how they will
areas takes guidance and practice. instruct, intervene with, and evaluate the expected and unex-
The Collaborative Practice Framework (CPF; see Figure pected outcomes of their instructional strategies. The reflective
1 on p. CE-2) is drawn from models of Developmental Work and appreciative considerations in Table 1 guide the occupa-
Research (Engeström, 2000), the Plan-Do-Study-Act Cycle tional therapy practitioner’s use of the CPF to develop compe-
(Taylor et al., 2014), reflective practices (Laverdure, Seruya, tent collaborative practice.
Stephenson, & Cosbey, 2016), and appreciative inquiry (Cooper- Establishing effective collaboration involves mutual commit-
rider, Whitney, & Stavros, 2008) to provide guidance in devel- ment and shared accountability. Interdisciplinary teams who
oping collaborative practice. The CPF illustrates a process that commit to collaboration can make lasting changes to the phys-
school-based occupational therapy practitioners can use to build ical, academic, and social contexts that contribute to student
collaboration competencies and establish effective partnerships progress.

Table 1: Building Contemporary Competent Collaborative Practice Using the Collaborative Practice Framework
Communication Interpersonal Skills Building Partnerships
Identify Issues • What are the key issues, and how are • Who are the key stakeholders affected by •H ow do these performance issues affect
they affecting learning, occupation, and the performance issues? the student’s function across environments
performance in the classroom? •H  ow might they be drawn into the col- (e.g., home, community, school)?
• What are the causes and contributing laboration and problem solving process? •D oes the team share a common under-
factors associated with these issues? (Ensure that all individuals with information standing of the issues?
• What are the student’s perception of the are heard so as not to miss key informa- • How might change in these areas influence
issues? tion, resulting in disengagement.) productivity, relationships, and satisfaction?
• Are the issues the result of larger systemic
issues that need to be addressed concom-
itantly?
Identify Solutions • What outcomes are expected? What will •H  ow will buy-in among stakeholders • What physical, knowledge, skill, behavior,
success look like? (including the student) be facilitated? cultural, and attitudinal affordances and
• What theory of change will be used to •D  o interventions match the capacities barriers affect the intervention implemen-
design interventions? and competencies of those expected to tation?
• How will interventions target key areas of implement them? •H  ow will the “who, what, where, when,
concern and expected outcomes? • Is the intervention design consistent with and how” of intervention implementation
• What evidence suggests that the interven- the context and contextual expectations? be managed?
tion will be successful? What predictions • What resources (human, material, and
might be made? financial) will be needed?
• How will the intervention be carried over •H  ow will intervention fidelity be moni-
and sustained? tored?
• What roles will each of the members
of the team play in implementing the
intervention?
• What are the possible outcomes if the
intervention is not successful?

Identify Measures • How will progress be measured? • How will team members identify inconsis- •H
 ow, by whom, where, and when will data
• How will confounding factors (absences, tencies in intervention carry over? be collected and reviewed?
illnesses, behavior changes, etc.) be • How will the potential for bias and mis-
viewed relative to intervention success? leading results be mitigated?
• How will change be attributed to the
intervention?
Identify Outcomes • How will team members communicate • How will the team members respond with •H
 ow will outcomes be evaluated?
the changes in learning, occupational agility to lack of progress or unanticipated •H
 ow will the team analyze expected and
engagement, and performance? negative effects of the intervention? unintended outcomes (how and why the
• How will the need for intervention change intervention worked or did not work)?
or redefinition of goals be addressed?

AUGUST l OT PRACTICE, 22(15) ARTICLE CODE CEA0817 CE-3

 Continuing Education Article
CE Article, exam, and certificate are also available ONLINE. Register at http://www.aota.org/cea or call toll-free 877-404-AOTA (2682).

Designing Embedded Interventions l What are the current naturally occurring occupations?
The purpose of special education is to “address the unique needs l What interventions can be embedded into these occupations
of the child that results from the child’s disability; and to ensure while minimizing disruptions?
access of the child to the general curriculum, so that the child l How can the strengths and skills of the interdisciplinary
can meet the educational standards … that apply to all children” team and other staff members be considered when develop-
(IDEA, 2004). In this context, occupational therapy is a related, ing the interventions?
or supportive, service provided expressly to “assist a child with a l How can the interventions be designed to use naturally
disability to benefit from special education” (IDEA, 2004). The occurring materials and supports?
student’s educational program must include academic and func- l What additional training and other supports are necessary
tional goals that “meet the child’s needs … to enable the child for the intervention to be successful?
to be involved in and make progress in the general education
curriculum” (IDEA, 2004). Through education, consultation, and face-to-face service
The Occupational Therapy Practice Framework: Domain & delivery in naturally occurring contexts, occupational therapy
Process, 3rd Edition (Framework; AOTA, 2014b) provides prac- practitioners can collaborate with school teams to achieve the
titioners with guidance to implement best practices within the best outcomes for students.
context of these complex regulatory requirements. Both IDEA
and the Framework expect occupational therapy practitioners to A Study of the Current Use of Collaborative and Contextual Practice
(1) collaborate with clients for developing the evaluation pro- In a recent online survey of 1,105 U.S. school-based occupa-
cess, goals, and intervention planning and implementation; (2) tional therapy practitioners, Gaylord (2016) investigated the
consider function and participation and promote access to and proportion of time practitioners deliver contextual and collab-
progress in the general education curriculum; and (3) measure orative services. Eleven percent of survey respondents were
the outcomes of their intervention. Given that the limited hours high users of contextual services (more than 75% of their time
of the school day are filled with academic and non-academic was spent delivering contextual services), 43% were medium
activities, providing services through a contextually based model users (25%–75% of their time), and 45% were low users
enables occupational therapy practitioners to address each (less than 25% of their time). Relatedly, 15% of respondents
student’s unique needs. described themselves as low users of pull-out services, 38%
Table 2 on page CE-5 illustrates the steps that the occu- were medium users, and 46% were high users. When provided
pational therapy practitioner may take to enact a contextual a checklist to choose reasons that supported their decision
practice that supports student access, occupational engagement, to use a pull-out method of service delivery, half or more of
and school participation (Laverdure & Rose, 2012). respondents reported they did not use the naturally occur-
When designing embedded interventions, occupational ring location and activity because (1) it contained barriers to
therapists can engage in therapeutic use of occupations learning, such as noise or visual distractions; (2) they wanted
and activities. Consistent with the Framework, therapists, to build a therapeutic relationship; (3) they wanted to achieve
in collaboration with educators and other members of the better student compliance or behavior; and (4) there were
school staff, can identify opportunities for the student to scheduling problems. Between 19% and 48% of respondents
develop skills through naturally occurring activities in natural reported other reasons, such as occupational therapy disrupt-
locations. Targeting these opportunities decreases the need ing others; student embarrassment; workplace standards; or
for generalizing skills and allows the practitioner to model parent, teacher, or occupational therapy practitioner prefer-
strategies that the teachers and other staff can implement ence. Survey respondents described their use of collaborative
throughout the school day. Additionally, the practitioner service using the same categories. Three percent were high
can provide education to the teachers and staff, including in users, 33% were medium users, and 64% were low users of
the specific implementation of strategies and in developing collaborative service.
purposeful activities that promote skill development. For There were many associations between demographic groups
example, an occupational therapist can support a general edu- and service delivery methods. The highest users of pull-out ser-
cation teacher in developing transition activities and activi- vices and the lowest users of both collaborative and contextual
ties for student self-selection after the completion of group services included contract workers and practitioners who rated
work. These activities can promote specific skill development themselves as “unprepared” or “somewhat prepared” to provide
through purposeful activity, such as handwriting skills, fine contextual services. Conversely, the lowest users of pull-out
motor skills, and self-regulation. services and the highest users of both collaborative and contex-
As previously noted, throughout the process of designing tual services included employees and practitioners who rated
embedded interventions, the occupational therapist must themselves as “well prepared” to provide contextual services.
demonstrate strong communication and collaboration skills. In The narrative comments supported the data with a call for spe-
addition, they should consider the following questions: cific training to prepare practitioners for best practice service

CE-4 ARTICLE CODE CEA0817 AUGUST l OT PRACTICE, 22(15)

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.

delivery and for referral, documentation, and billing systems to l Reading publications (e.g., Best Practices for Occupational
reflect best practices. Therapy in Schools [Frolek Clark & Chandler, 2014] and Col-
laborating for Student Success: A Guide for School-Based Occu-
Overcoming Barriers to Collaborative and Contextual Service pational Therapy [2nd Edition; Hanft & Shepherd, 2016])
Delivery l Sustaining membership in AOTA for access to resources such
Collaborative and contextual service delivery is essential to as the Journal Club Tool Kit, School-Based FAQs, School-
implementing best practices in school-based settings; however, Based Mental Health Toolkit, American Journal of Occu-
it is challenging to overcome the barriers present within the pational Therapy, the Early Intervention & School Special
complex dynamics of school-based practice. Perceived barriers Interest Section, and networking opportunities through OT
include ineffective communication, challenges transitioning Connections (www.otconnections.org)
from an expert to a collaborative model, problematic student l Seeking mentorship under the guidance of more experienced
behavior, issues with scheduling, disturbing others, student practitioners who model best practices
embarrassment, workplace standards, and individual pref- The second way to overcome barriers is through relationship
erences (Gaylord, 2016). Such barriers can be addressed by building with stakeholders in school settings, including stu-
preparing new practitioners, building stakeholder relationships, dents, teachers, parents, administrators, therapists, and policy
and shifting from a caseload to a workload model. makers. According to the Framework, the therapeutic use of self
The following tools can be used to enhance skills in collabo- is considered an “integral part of the OT process ... which allows
rative and contextual practice: occupational therapy practitioners to develop and manage their
l Pursuing continuing education (e.g., formal coursework, therapeutic relationship with clients” (p. S12). Building mutual
fieldwork supervision, mentorship, reading evidence-based understanding, respect, and trust through the therapeutic use
literature; AOTA, 2017) of self sets the foundation for successful collaboration. Profes-
l Examining practice and determining strengths, interests, sional learning communities and communities of practice are
and learning needs through self-assessments (e.g., AOTA’s additional methods to enhance collaboration (Frolek Clark &
Professional Development Tool [AOTA, 2013]) Chandler, 2014). When practitioners have strong relationships
l Accessing state and federal guidelines with all stakeholders and model best practices for others to

Table 2. Steps for Supporting Student Access, Occupational Engagement, and School Participation (Laverdure & Rose, 2012)
OT Process Action Steps
Evaluation • Synthesize the student’s health-related parameters (health conditions, body function and structures, and the environment) and their
educational trajectories and transitions.
• Identify affordances and barriers that influence access to and participation in school activities.
• Identify roles, routines, and skills required to participate effectively in the school community.
• Evaluate participation and performance in meaningful contexts and environments.
• Use occupation-based, functional, self-assessment, and quality-of-life measures that build understanding of the student’s perspective of
disability and participation and the personal and contextual factors that facilitate or interfere with participation.
Goal Setting • Translate the unique understanding of performance components, task demands, and environmental factors that support or hinder access,
participation, and ability to benefit from the educational curriculum.
• Identify goals as student goals that do not belong to one discipline or professional.
• Focus on student strengths, need for accommodations, and barriers that impede function rather than on remediating impairment. For
example, goals related to self-regulation may be replaced with goals related to work completion or appropriate peer interactions.
• Base goals on student interests, needs, values, and potential outcomes for future work and independent living.
• Be sure goals include objective, measurable criteria that can be easily evaluated throughout the day and that reflect learning and achievement.
• Empower students to set realistic goals, improve understanding of their strengths and challenges, and develop self-advocacy skills.
Intervention • Modify physical and social environments and task demands, creating a culture of universal accessibility and inclusivity.
Planning • With the interdisciplinary team, co-develop accessible learning activities; strategies to modify and accommodate the student’s learning
needs to facilitate active participation; and formative, summative assessment strategies to ensure learning.
• When required to remediate specific impairments in body function, focus intervention on minimizing the impact of impairments on partici-
pation (this is often short term).
Intervention • Provide intervention during naturally occurring activities across the school campus.
Implementation • Only remove students from their natural contexts and environments when there is specific criteria established, including duration and
intended outcome.
• Anticipate critical transitions and challenging turning points throughout the student’s OT Process Action Steps education, and support
participation.
• All members of the interdisciplinary team support all goals and collaboratively collect data throughout the school day.
• All members of the interdisciplinary team collaborate in monitoring progress, analyzing data, measuring outcomes, and making informed
decisions for the future.

AUGUST l OT PRACTICE, 22(15) ARTICLE CODE CEA0817 CE-5

 Continuing Education Article
CE Article, exam, and certificate are also available ONLINE. Register at http://www.aota.org/cea or call toll-free 877-404-AOTA (2682).

more clearly understand the value of occupational therapy, 2. Develop outcome measures that address our full scope of
parents, teachers, therapists, and others are more likely to shift occupational therapy practice and identify outcomes of value
their preferences away from pull-out services in support of con- to all stakeholders
textual, collaborative services. 3. Identify what is working when and under what conditions,
Third, school-based practitioners must shift from a caseload and build partnerships with researchers to design and
to a workload model to alleviate scheduling issues and enhance conduct research that is relevant to the profession and
workplace standards. The workload model is strongly endorsed stakeholders
by occupational therapy, physical therapy, and speech-language 4. Develop ways that practitioners and scholars can better
therapy national organizations (AOTA, American Physical Ther- disseminate knowledge in a way that is understood by the
apy Association [APTA], American Speech and Hearing Associ- profession, its practitioners, and its many stakeholders.
ation [ASHA], 2014). A caseload model refers to the number of
intervention sessions within a time period, whereas the work- REFERENCES
load model considers the complex demands on practitioners American Occupational Therapy Association. (2013). Professional development tool.
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American Occupational Therapy Association. (2014b). Occupational therapy
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(1) Completing a time study of activities and tasks performed, pational Therapy, 68, S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006
(2) calculating the percentage of time performing each activity, American Occupational Therapy Association. (2016a). 2011 Accreditation Council
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to the supervisor (AOTA, 2014a). A workload model increases porate/Files/EducationCareers/Accredit/Standards/2011-Standards-and-In-
scheduling flexibility for collaborative and contextual services, terpretive-Guide.pdf
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Providing services within the school setting is complex and American Occupational Therapy Association, American Physical Therapy
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that improve health, wellness, and satisfaction; deliver consis- dren/APTA-ASHA-AOTA-Joint-Doc-Workload-Approach-Schools-2014.pdf
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educational partners have resulted in increased active student tional Therapy in Pediatrics, 26(3), 89–110.
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dances, and barriers to providing it; and building competencies handbook: For leaders of change (2nd ed.). San Francisco: Berrett-Koehler.
in collaboration that build team decision making and promote Education for All Handicapped Children Act of 1975, Pub. L. 94-142, renamed
the Individuals With Disabilities Education Improvement Act, codified at 20
practice innovation may optimize collaborative decision making U.S.C. § 1400–1482.
and enable practitioners to design and implement best practice. Engeström, Y. (2000). Activity theory as a framework for analyzing and rede-
As a practice community, school occupational therapy practi- signing work. Ergonomics, 43, 960–974.
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of their work in schools with all stakeholders—teachers, project. Early Childhood Education Journal, 37, 127–135.
parents, administrators, policymakers, and people with Gutkin, T. B. (2002). Training school-based consultants: Some thoughts on
grains of sand and building anthills. Journal of Educational & Psychological
disabilities Consultation, 13, 133–136.

CE-6 ARTICLE CODE CEA0817 AUGUST l OT PRACTICE, 22(15)

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See below for details.

Handley-More, D., Wall, E., Orentlicher, M. L., & Hollenbeck, J. (2013, June).
Working in early intervention and school settings: Current views of best
practice. Early Intervention & School Special Interest Section Quarterly, 20(2),
Final Exam
1–4.
Article Code CEA0817
Hanft, B. & Shepherd, J. (2016). Collaborating for student success: A guide for
school-based occupational therapy (2nd ed.). Bethesda, MD: AOTA Press. August 22, 2017
Individuals with Disabilities Education Improvement Act of 2004. Pub. L. 108-
446, 20 U.S.C. § 1400–1482. Providing Collaborative and Contextual Service in School
Laverdure, P., Paulsen, M., Rumery, E., & Strunk, A. (2016). Promoting inclu- Contexts and Environments
sion for children with disabilities and their families. OT Practice, 21(5), 9–12.
Laverdure, P., & Rose, D. (2012). Educational relevance in school-based occupa- To receive CE credit, exam must be completed by
tional and physical therapy. Physical & Occupational Therapy in Pediatrics, 32, August 31, 2019.
347–354.
Laverdure, P., Seruya, F., Stephenson, P., & Cosbey, J. (2016). Paradigm tran- Learning Level: Intermediate
sitions in pediatric practice: Tools to guide practice. SIS Quarterly Practice
Connections, 1(2), 5–7. Target Audience: Occupational Therapists and Occupational Therapy
Reid, D., Chiu, T., Sinclair, G., Wehrmann, S., & Naseer, Z. (2006). Outcomes of Assistants
an occupational therapy school-based consultation service for students with
fine motor difficulties. Canadian Journal of Occupational Therapy, 73, 215–224. Content Focus:  ontext and environments; Professional issues:
C
interprofessional collaboration
Silverman, F. (2011). Promoting inclusion with occupational therapy: A
co-teaching model. Journal of Occupational Therapy, Schools, & Early Interven-
tion, 4, 100–107. http://dx.doi.org/10.1080/19411243.2011.595308
1. Best practice in school settings can be characterized by
Spencer, C., Turkett, A., Vaughan, R., & Koenig, S. (2006). School-based prac-
tice patterns: A survey of occupational therapists in Colorado. American Jour-
which of the following?
nal of Occupational Therapy, 60, 81–91. http://dx.doi.org/10.5014/ajot.60.1.81 A. Testing the student using norm-based assessment tools
Taylor, M. J., McNicholas, C., Nicolay, C., Darzil, A., Bell, D., & Reed, J. E. B. Using evidence and data to conduct evaluations and
(2014). Systematic review of the application of the plan–do–study–act meth- make decisions about instruction and intervention
od to improve quality in healthcare. BMJ Quality & Safety, 23, 290–298.
C. Providing services in a setting free of distractions and
Villeneuve, M. (2009). A critical examination of school-based occupational
therapy collaborative consultation. Canadian Journal of Occupational Therapy, interruptions
76, 206–218. D. Providing a list of effective interventions to the teacher
Villeneuve, M. A., & Shulha L. M. (2012). Learning together for effective col- to be carried over in the classroom
laboration in school-based occupational therapy practice. Canadian Journal of
Occupational Therapy, 79, 293–302.
2. Several important outcomes are achieved when collab-
Wehrmann, S., Chiu, T., Reid, D., & Sinclaii, G. (2006). Evaluation of occupa-
tional therapy school-based consultation service for students with fine motor orative relationships among team members are estab-
difficulties. Canadian Journal of Occupational Therapy, 73, 225–235. lished and nurtured. They include:
A. Innovative teaching, supports, strategies, and
technologies
B. Improving skills that impact student performance on
academic and developmental measures
C. Decreased down time in service delivery
D. Identifying members of the team that dislike working
How to Apply for with students with disabilities
Continuing Education Credit 3. Which one of the following statements is true about
A. To get pricing information and to register to take the exam collaborative service delivery in schools?
online for the article Providing Collaborative and Contextual A. It works best when the expert occupational therapy
Service in School Contexts and Environments, go to www. practitioner provides consultation to other school
aota.org/cea, or call toll-free 877- 404-2682. adults.
B. Once registered and payment received, you will receive instant B. It works best when team members engage in in-depth
email confirmation with password and access information to discussions about student needs and design individual-
take the exam online immediately or at a later time. ized and innovative interventions.
C. Answer the questions to the final exam found on pages CE-7 and C. It decreases job satisfaction among school professionals.
CE-8 by August 31, 2019. D. It can occur as pull-out occupational therapy service
D. On successful completion of the exam (a score of 75% or more), delivery followed by consultation with other school staff
you will immediately receive your printable certificate. to bring them up to speed.

AUGUST l OT PRACTICE, 22(15) ARTICLE CODE CEA0817 CE-7

 Continuing Education Article
CE Article, exam, and certificate are also available ONLINE. Register at http://www.aota.org/cea or call toll-free 877-404-AOTA (2682).

4. Which of the following is an example of the application of 8. The Collaborative Practice Framework does not include
contextual practice in the occupational therapy process? which of the following?
A. Helping students identify their limitations, and working A. Identifying issues that influence learning and occupa-
on exercises in the back of the classroom beside their tional performance
peers to overcome them B. Selecting the lead expert, who will identify which strate-
B. Working with teachers to adapt activities and modify gies and interventions to implement
environments to enhance a student’s access to and partic- C. Identifying how progress will be monitored and perfor-
ipation in meaningful roles and routines mance data analyzed
C. Focusing exclusively on the skills of early childhood to D. Identifying which outcomes have been achieved
establish a solid foundation for later years
D. Serving the team as the expert on sensory, motor, and 9. How can barriers to contextual and collaborative prac-
visual-perceptual development in children tice be overcome?
A. Establish clear role boundaries of each member of the team
5. Why is collaborative and contextual service delivery in B. Build strong relationships with all stakeholders
schools important for student outcomes? C. Carefully manage caseload requirements
A. It allows individual team members to leverage their D. Identify data collection methods to be carried out by the
discipline’s most effective supports, strategies, and teaching staff
technologies to enable a student to access and participate
successfully in their educational program. 10. Which of the following best describes why transitioning
B. Modeling partnerships can help a student interact more from a caseload to workload model can support collabo-
effectively with peers. rative service delivery?
C. It identifies solutions for the physical, knowledge, skill, A. A workload model increases the number of students on a
behavior, and attitudinal barriers that influence a stu- practitioner’s caseload, thus giving the practitioner more
dent’s participation. practice in delivering collaborative service.
D. It enables students and families to make informed choic- B. A workload model is based on all job duties, including
es about the most effective interventions. collaborative service, not just the number of students on
the caseload. This reduces the time needed for practi-
6. Which is not true about contextual service delivery in tioners to be present where and when other school staff
schools? work with students.
A. It uses naturally occurring activities. C. A workload model creates more time in a practitioner’s
B. It uses naturally occurring contexts and environments. schedule by identifying them as the expert who instructs
C. It makes it difficult for the therapist to do ongoing assess- others to implement the interventions.
ment of the factors impacting participation and success. D. A workload model is based on practitioners sharing their
D. It supports collaborative service delivery by placing the duties with school support staff, creating time to collabo-
occupational therapy practitioner with the student and rate with teachers.
staff who work with the student during times the student
needs support. 11. Which of the following positively affects collaboration?
A. Assuming an expert role in the collaboration process
7. Which of the following is not an example of collaborative B. Setting aside time at the beginning of the school year for
and contextual service delivery in schools? collaboration
A. Joining a student during lunchtime to support staff and the C. Thoroughly understanding the roles of team members
student who is not yet fluently using adaptive eating utensils D. Providing evidence-based services in an quiet one-on-one
B. Joining the student during small group math instruction setting adjacent to the classroom
to help work out a way the student can successfully hand-
write vertically oriented math problems using proper 12. Interdisciplinary team members must do which of the
column alignment following in order to collaborate effectively?
C. Using the naturally occurring writing assignment from A. Discuss the expected outcomes of students within the
the teacher but removing the student to a separate area specific educational context.
to introduce raised-line adaptive writing paper B. Share discipline-specific interventions to instruct and
D. Joining a preschool classroom during story time to provide intervention to meet the student’s expectations.
help students and staff understand how to weave C. Consider the perspectives of all of the specialists on the team.
core-strengthening poses (e.g., tall kneel) into the story D. Consider each of the student’s limitations that impact
time activities. performance.
CE-8 ARTICLE CODE CEA0817 AUGUST l OT PRACTICE, 22(15)