Article Canadian Journal of Occupational Therapy

1-13
DOI: 10.1177/00084174241310078

Occupational Therapist–Teacher © CAOT 2025

Collaboration in Inclusive Education in Article reuse guidelines:

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Québec: A Qualitative Descriptive Study www.cjotrce.com

Collaboration entre ergothérapeutes et personnel enseignant en

contexte d’inclusion scolaire au Québec : une étude qualitative
descriptive

Lina Ianni , Chantal Camden , Wenonah Campbell ,

Heather Colquhoun, and Dana Anaby

Key words: Collaboration; Inclusion; Schools; Students with special needs; Team practice.

Mots clés : Collaboration ; Écoles ; Élèves ayant des besoins particuliers ; Inclusion ; Pratique d’équipe.

Abstract
Background: In inclusive schools, collaboration between occupational therapists (OTs) and teachers has the potential to build
capacities among these school-team members working with students with disabilities. Current evidence supports multi-tiered
delivery models, such that OT interventions are integrated within the context of school life. Collaboration, however, is a complex
multifaceted phenomenon that poses systemic, organizational, or interpersonal challenges. Purpose: This qualitative descriptive
study explored the perspectives on current and ideal collaborative practices and associated contextual barriers and facilitators
related to collaboration, as described by elementary teachers and OTs. Method: Two focus groups were conducted with OTs
(n = 5) and elementary teachers (n = 6) working in inclusive schools in Québec (Canada) in French and English language settings.
Qualitative data were transcribed and analyzed thematically. Findings: Four thematic categories were identified: Organization of
services scaffolds collaborative practices; varying perspectives of the OT role influence collaboration; establishing and navigating
collaborative relationships; and considerations for optimal collaboration. Conclusion: These findings have practice and policy
implications regarding the organization of OT services as well as team professional development. Understanding these challenges
is fundamental to tailoring future knowledge translation interventions to optimize school collaboration.

Résumé
Description. Dans les écoles inclusives, la collaboration entre les ergothérapeutes et le personnel enseignant a le potentiel de
renforcer les capacités des membres de l’équipe scolaire qui travaillent avec les élèves ayant un handicap. Les données probantes
actuelles appuient les modèles de prestation à plusieurs niveaux, de sorte que les interventions d’ergothérapie sont intégrées
dans le contexte de la vie scolaire. La collaboration, cependant, est un phénomène complexe et à multiples facettes qui pose
des défis systémiques, organisationnels et interpersonnels. But. Cette étude descriptive qualitative explore les perspectives
sur les pratiques collaboratives actuelles et idéales ainsi que les obstacles contextuels et les facilitateurs associés en lien avec
la collaboration, tels que décrits par des enseignantes et enseignants du primaire et des ergothérapeutes. Méthodologie.
Deux groupes de discussion ont été menés avec des ergothérapeutes (n = 5) et des enseignantes et enseignants du primaire
(n = 6) travaillant dans des écoles inclusives au Québec (Canada) en contexte francophone et anglophone. Les données qualitatives
ont été transcrites et analysées thématiquement. Résultats. Quatre catégories thématiques ont été identifiées: L’organisation des
services soutient les pratiques de collaboration; Les perspectives variées du rôle de l’ergothérapeute influencent la collaboration;

Corresponding author: Lina Ianni, School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC H3A 0G4,
Canada; Phone: (514) 398-4400 Ext. 00394. Email: [email protected]
2 Ianni et al.

L’établissement des relations de collaboration et la navigation parmi celles-ci; et Considérations pour une collaboration optimale.
Conclusion. Ces résultats ont des implications pratiques et politiques en ce qui concerne l’organisation des services
d’ergothérapie ainsi que le perfectionnement professionnel de l’équipe. Comprendre ces défis est fondamental pour adapter les
futures interventions d’application des connaissances de manière à optimiser la collaboration scolaire.

Introduction motor, sensory, emotional) or consultative support (e.g.,

accommodations) (Grandisson et al., 2020; Jasmin et al.,

I
n school-based occupational therapy, collaboration 2019). However, the high volume of referrals makes it difficult
between educators and school occupational therapists
to meet students’ needs (Grandisson et al., 2020; Jasmin et al.,
(OTs) is fundamental in any service delivery model for 2019). The provincial education ministry is shifting towards
students presenting with special needs who are integrated tiered models to better support inclusion (Ministère de
with inclusive schools. Tiered models offer a continuum of ser-
l’Éducation, 2020). Recent research highlights the benefits of
vices to support students with special needs—where tier one increased collaboration, coaching, staff training, and school-
offers universal programming to benefit all students, tier two wide inclusive practices within these models (Rajotte et al.,
includes targeted group interventions and tier three emphasizes
2023). This shift calls for a reassessment of service delivery
individualized support (VanderKaay et al., 2021). OT–educator approaches and collaborative practices.
collaboration is essential for successfully implementing tiered Previous research shows that preschool teachers in Québec
service models, including rehabilitative services (VanderKaay
may lack full knowledge of the OT role in schools (Beaudoin et
et al., 2021). For instance, tiered models such as Response-to- al., 2019). Emerging evidence supports tiered services, with
Intervention (RtI) and Partnering for Change (P4C) are known tier-one support (e.g., workshops, consultations) relying on
to have benefits such as greater student participation, decreased
school team collaboration and capacity-building (Camden
number of referrals for special education interventions, improved et al., 2021). Effective tiered services depend on collaboration,
teacher engagement in professional development, and increased capacity-building, and curriculum-relevant, authentic services
collaboration in school teams (Anaby et al., 2019; Camden
(Vanderkaay et al., 2021). Future research is needed to
et al., 2021; Clark et al., 2017; Laverdure & Rose, 2012; explore and advance collaborative teamwork in school OT
Missiuna et al., 2012). practice (Beaudoin et al., 2019; Jasmin et al., 2019). While
Despite positive outcomes and evidence supporting tiered
OT support extends to all school team members, this study
service models that are collaborative, implementation chal- focuses on OT–teacher collaborations.
lenges remain. Although OTs and teachers agree that collabora- This qualitative descriptive study is the first phase in a
tion is important and necessary (Wintle et al., 2017), studies
larger, two-phase project. The findings from this first phase
involving OTs and teachers reveal barriers to these collabora- will inform the development of a knowledge translation (KT)
tive relationships (Benson et al., 2016; Truong & Hodgetts, intervention, the second phase, aimed at optimizing collabora-
2017; Wintle et al., 2017). These include teachers’ confusion
tion among OTs and teachers. To provide a more nuanced
over the OT role, limited communication opportunities, and and in-depth exploration of how collaboration occurs between
teachers’ desire for OTs to increase awareness of classroom occupational therapists and teachers in Québec elementary
constraints (Truong & Hodgetts, 2017). Additionally, profes-
schools, this study aims to explore the perspectives on current
sionals may not be adequately skilled or knowledgeable about and ideal collaborative practices and associated contextual bar-
teamwork collaborative processes to support young students riers and facilitators within their local school settings. In addi-
(Hillier et al., 2010). Collaboration involves trust, clear commu-
tion, perspectives on preferred learning strategies and
nication, mutual respect, conflict resolution, shared goals, methods to optimize collaboration were elicited to inform
active participation, and shared decision-making (Griffiths future KT interventions.
et al., 2021). These factors are highly contextualized and
must be carefully considered when examining service delivery
in local education settings, as well as in the development of
knowledge translation (KT) interventions aimed at improving Methods
collaborative practice, as recommended in the literature (Ianni The overall project (first and second phases) follows a sequen-
et al., 2023; VanderKaay et al., 2021). tial embedded design (Creswell, Klassen, Plano Clark & Smith,
In Québec, education policy supports the inclusion of chil- 2011), where the first phase (i.e., this study) utilizes qualitative
dren with special needs in local schools (Tétreault et al., 2010), methods, followed by the second intervention phase, which will
but challenges remain in organizing services for their integra- incorporate quantitative and qualitative methods. Ethics
tion (Ducharme & Magloire, 2018). School service centers allo- approval for both phases was obtained by the Research Ethics
cate funding based on a coding system tied to specific Board at McGill University.
diagnoses, reflecting a medical model of referral-based services In this qualitative descriptive study (Sandelowski, 2000),
(Cantin, 2021). Initially, school-based OT services followed two focus groups were conducted: one with elementary
this model, with referrals based on individual needs (e.g., school teachers (n = 6) and one with school OTs (n = 5).

Canadian Journal of Occupational Therapy

Canadian Journal of Occupational Therapy 0(0) 3

Focus group methods were used as they allowed participants to teacher participants with less than 1 year of experience were
discuss various topics and share their satisfaction and/or dissat- excluded. Convenience sampling was used for recruitment:
isfaction with services (Green & Thorogood, 2018). This also teachers were contacted via union newsletters, while OTs
allowed them to identify differences and similarities in opinions were recruited through social media ads and emails to a
and perspectives, to shed light on their realities, and to explore network of Québec OTs. All interested participants meeting
“what they really think” (Freeman, 2006, p. 494; Krueger & the criteria were included.
Casey, 1994).
The 2-h focus group sessions, facilitated by the first author
(LI), were conducted via Microsoft Teams due to COVID-19, Data Collection and Analysis
enabling greater participant engagement across school boards Written and verbal consent was obtained from all participants.
and service centers. A 10-question guide structured the discus- Using LimeSurvey, they completed a brief demographic
sion (see Appendix A). Questions related to barriers and facil- survey about their work experience. Focus groups were
itators were developed by drawing on elements of behavioral recorded via Microsoft Teams and transcribed. Each participant
change and the determinants of successful collaboration by was assigned an anonymized ID. Thematic analysis followed
San Martín-Rodríguez et al. (2005) and by the Theoretical Braun and Clarke’s (2006) steps, with an inductive approach
Domains Framework (TDF) (Atkins et al., 2017), to identify staying “close to the data” to identify key patterns in partici-
factors influencing collaboration and the factors that would pants’ accounts, experiences, views, and beliefs (Green &
need to change to improve collaboration. The research team Thorogood, 2018).
(A4 and A2), who have extensive experience in KT research The first author and a research assistant (RA) indepen-
in school-based settings, reviewed and provided feedback on dently coded the two focus group transcripts. A first meeting
the focus group guide. was held to discuss initial codes for the first half of both tran-
A 20-min presentation was provided at the onset of the scripts. Then, the remainder of the transcripts was coded, and
focus group discussion to introduce the topic of collaboration a subsequent meeting was held. A codebook was compiled.
and initiate the dialogue. Please refer to Table 1 for a The first author and the RA independently categorized codes
summary of the topics presented and corresponding references. into overarching initial themes. Meetings were held to discuss
Both groups received the same presentation. Due to language the thematic categories and to reach a consensus on a list of
preferences, the teacher presentation was offered in English, final themes, which were then reviewed with the research team.
and the OT presentation was provided in French. The first author has work experience as a school OT and
engaged in reflexivity of biases, beliefs, and experiences
throughout the coding process (Braun & Clarke, 2019). Both
Inclusion Criteria and Recruitment coders have experience with conducting qualitative research
Participants were OTs and teachers from southern Québec in the field of rehabilitation and worked in interdisciplinary
public schools, including rural, suburban, and urban settings, teams. The quotes from the French-speaking participants were
within both English and French school boards. OT and translated to English for this paper.

Table 1
Presentation Content for Focus Groups Results
Topic References—Examples Participant Characteristics
Table 2 summarizes participant characteristics. The teachers
OT role in schools Hanft and Shepherd (2016) worked in predominantly English-language schools. In the
Service delivery models Garfinkel and Seruya (2018);
Tiered models of service Missiuna et al. (2012); Vaughn and
OT group, four OTs worked in French-language schools
delivery Fuchs (2003) and one OT worked in English-language schools. All partic-
Evidence-based Anaby et al. (2018); Clough (2019); ipants worked in schools located in southern Québec regions.
recommendations for Laverdure and Rose (2012); The number of schools assigned to each OT ranged from 3 to
collaboration Missiuna et al. (2015); Villeneuve 30 schools, with varying service delivery models also
and Shulha (2012) reported.
Collaboration in schools and Bolton and Plattner (2019); Hillier
current research et al. (2010); Idol et al. (1995);
Ritzman et al. (2006); Wintle et al.
(2022) Themes
Definitions of collaboration Cook and Friend (2010); CTREQ A total of four thematic categories were generated from the
(2018) focus group discussions: (a) Organization of services scaffolds
Models and frameworks of Bronstein (2003); San collaborative practices; (b) varying perspectives of the school
collaboration Martín-Rodríguez et al. (2005);
OT role influence collaboration; (c) establishing and navigating
Smith (2009)
collaborative relationships; and (d) considerations for optimal
See Appendix B for the complete reference list. collaboration. Please see Figure 1.

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4 Ianni et al.

Table 2
Participant Characteristics (n = 11)

Teacher Group OT Group

Grade(s) Taught/ Years of Teaching Number of Years of Experience Years of Experience
Participant Subject Taught Experience Participant Assigned Schools as an OT Working as a School OT

T1 Grades 3 and 4 11 OT1 7 3 3

T2 Pre-K 10 OT2 8 14 3
T3 Resource teachera 34 OT3 30 5 5
Grades 2–6
T4 Grades 3–5 7 OT4 4 5 5
T5 Resource teachera 14 OT5 3 10 3
Grades 5 and 6
T6 Physical education 17
specialist
Grades 1, 5 and 6
a
Resource teacher: In Québec, a resource teacher offers individualized services to “at-risk” students who may present with learning challenges, and they work with
their teacher colleagues to become familiar with pedagogical best practices (Boyer, 2015).

Figure 1. Thematic categories and sub-themes.

1. Organization of service scaffolds collaborative practice (a) Access to services

This thematic category describes the organization of ser- The teachers expressed that although they appreciate having OT
vices, that is how services are accessed and rendered, according services and recognize the importance of OT in schools, access-
ing such services can be challenging and confusing as referral
to the experiences of the OT and teacher participants. There are
three sub-themes within this category. Two themes were procedures (e.g., forms to complete) or special education guide-
common to both the OT and teacher groups: (a) Access and lines are not always clear, even at a provincial level:
delivery of services and (b) availability of resources. One It would be nice if the guidelines were similar across Quebec,
theme was unique to the teacher group: (c) Collaboration pro- that everybody knows the same procedures and we followed
cesses and mechanisms. them. (T3)

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Canadian Journal of Occupational Therapy 0(0) 5

Additionally, access may be influenced by a lack of knowl- (b) Availability of resources

edge about the roles and services offered by various profession-
als (e.g., school psychologists, speech-language pathologists,
Availability of resources was discussed in both groups, primar-
and OTs). As one teacher stated, “a lot of teachers don’t even
ily as a challenge regarding time and budgets. Both teachers and
know what they are looking for” (T6).
OTs reported insufficient time to meet and discuss cases or
Teachers and OTs discussed how services are organized,
share ideas. Participants in both groups stated discussions are
which guides the referral process and influences the extent of
often held in the doorway or hallway, which impacts how strat-
collaboration. For instance, teachers often stated that “OTs are
egies, tools, or plans are implemented because “it’s just not
spread so thin” as they travel to multiple schools, thus pres-
organized officially” (T4), which was also echoed in the OT
ence is infrequent. The teachers described the main role of
group:
the OT is to evaluate students individually, which can limit
collaborative interactions due to the lengthy waitlists and One of the organizational things that help is to liberate teachers
limited or inconsistent follow-up visits. OT intervention in and to give them time for workshops/trainings. (OT3)
the class in the form of activities/lessons was reported by
teachers to be infrequent. Additionally, teachers reported OTs also reported lacking time to follow up with classes or
that although students with higher priorities may have access students or to implement coaching/mentoring strategies.
to OT services through the referral process, other students Accordingly, funds to release teachers to attend meetings
with less significant needs may not necessarily benefit. (i.e., to hire replacements) are needed for collaborative
Contrarily, in instances where OT presence was consistent exchanges to occur. Protected meeting time was described as
and regular, this was reported to enhance the overall commu- important for both OTs and teachers to allow for exchanges
nication between OT and school staff and clarify referral pro- to take place. However, the time and money “is just not
cedures. To support the organization of services, having an there” (T6). Regarding capital resources, the OTs agreed that
‘ally’ or a person responsible in the school who understands if there were more OTs employed by their school service
the school professionals’ roles, such as the resource teacher center, this would result in fewer school assignments per OT,
or special education teacher, can help to establish wait-list and thus afford increased OT visibility in the schools. In addi-
priorities. tion, both OTs and teachers reported funds are needed to pur-
Similarly, the OTs often alluded to how organization and chase OT-recommended tools and equipment.
delivery of services within their school boards/service centers
shape the delivery of services, their in-school presence, and (c) Collaboration processes and mechanisms.
thus the scope of collaborative practices. Among the group,
the number of schools assigned per OT varied (i.e., 3‒30
schools per caseload). This variation not only affects how The teachers discussed the processes and mechanisms to
services are rendered but also the frequency of collaboration collaborate, which refers to the tools and mechanisms of collab-
with teachers and staff. One OT expressed, “out of sight, out oration—the “who, when, where, and how” of working
of mind” for how important in-school presence was for her collaboratively.
(OT1). In-school presence also supports teachers’ under- Teachers reported collaborative exchanges typically
standing of the OT role. Maintaining the same assigned involve the teacher and OT. However, they emphasized that
schools year after year was reported to help sustain collabo- support staff (e.g., classroom attendants) and parents are often
rative relationships and enhance the knowledge of OT not included in these meetings or discussions—and should
services. be. “When” and “where” collaboration occurs were frequently
The OTs generally described their service mandate using a mentioned as barriers. Arranging a time for the teacher and
school-wide or classroom-wide approach, rather than an individ- OT to meet was deemed a frequent challenge:
ualized approach. For example, one OT (OT2) stated she adopts You only get them so often and it’s like a quick “in the hallway”
“a more response-to-intervention approach.” Another OT (OT1) chat. There’s no time to sit and meet or even to implement every-
described how she designated ‘OT time’ in the teachers’ thing they want because it’s just not organized “officially.” (T4)
schedules and this was helpful in maintaining communication
and follow-up with the teachers: Suggestions such as knowing the professionals’ schedules
Teachers can “place” me in their schedule as a specialty. I do
in advance, meeting the OT at the beginning of the year to
prevention, health promotion, and coaching teachers…It’s “discuss bigger cases” (T6), and regular communication were
helpful in the class. (OT1) shared to support collaboration. “How” collaboration occurs,
such as the communication tools and mechanisms, was also dis-
However, most OTs described scheduling school visits as chal- cussed. Written communication, such as e-mail, reports, com-
lenging due to the number of assigned schools. In general, pleting questionnaires, and summaries of plans or
having professional autonomy to flexibly adapt their schedule recommendations, was appreciated by the teachers. The use
to accommodate school visits/meetings was viewed as favorable of virtual meetings was mentioned as an efficient way to collab-
to fostering collaborative relationships and their offer of service. orate, e.g.,:

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6 Ianni et al.

We have a good collaborative approach with our school board The OT group primarily described interventions that were done
and our consultants. We meet on a regular basis—due to in partnership with teacher colleagues and the roles they
COVID and using Microsoft Teams, we were able to meet assumed to facilitate these collaborative relationships.
more often. We don’t have to worry about them traveling Examples include: partaking in meetings; OT–teacher knowl-
from school to school. (T3)
edge exchange; the OT’s role as a consultant, coach, or
co-teacher; and assuming responsibilities beyond the OT role.
2. Varying perspectives of the school OT role influence OT–teacher meetings were generally described as important
collaboration for communication and sharing. They are opportunities for teach-
ers to discuss student concerns, ask questions, build strategies
The organization of services, as described, reveals how the together, exchange information, and develop relationships.
mandate and delivery of services can also influence the percep- OT–teacher knowledge exchanges, such as OTs offering
tion of the OT role from teachers and OTs. The teacher sub- workshops, were described to potentiate collaboration. Two
theme indicated from the discussion described the role of the OTs spoke positively about opportunities for teachers to
OT in the classroom, with the student, with the teacher, and attend OT professional development workshops or to partici-
within the school. The OT sub-theme focused mainly on pate in communities of practice (COPs). These workshops or
collaborative-based interventions and how these services culti- COPs are occasions to share information, model strategies
vate further collaboration within the school team. and address students’ skillsets that are important to teachers
(e.g., printing and writing). The OTs stated workshops allow
(a) The OT’s role with the student, the teacher, and within them to reach numerous individuals simultaneously. They
the classroom also serve as a reference when teachers describe concerns to
the OT. One OT expressed that when teachers and staff have
Teachers reported the primary OT mandate is to observe and been exposed to the same workshop, this can lead to a
carry out assessments with the students, whereby recommenda- “common language” (OT1).
tions are provided for the teacher and personnel to implement, The OTs further described their roles as consultants and
typically outlined in a report. The OTs also assist by confirming co-teachers in jointly developing activities with teachers to
or ruling out causes of a student’s difficulty he/she is experienc- build capacities. When partaking in this co-teaching or coach-
ing in the class. However, due to the OTs’ workload, availabil- ing relationship, OTs shared that teachers selected the goals
ity, and schedule, continuous collaborative consultation and the ‘local’ in-class materials were used, as described:
following an evaluation is lacking, as described by one teacher: We did co-teaching about writing skills as a team. I wasn’t just
an expert, they were experts of “their side.” We were all experts
There’s a lot on evaluation, but what do you do afterwards? You in our own domains. I found [this approach] facilitated the work
have recommendations, but how do you implement them? (T3) within this team. (OT5)

There was an expressed need for additional opportunities for The OTs spoke about the various roles they take on that go
teacher-OT discourse to implement proposed recommendations. beyond the scope of OT practice. One OT stated she is “there to
One teacher appreciated consulting the OT’s written report to help”, regardless of her OT role to facilitate her sense of belong-
help support a student. In situations with frequent interactions ing in the school. Partaking in social activities was also
with the OT following the assessment, teachers perceived this described to deepen connections with colleagues further:
as helpful as they can “spot-check” with the OT as needed (T6).
I participate in social activities. Sometimes I will get out of my role,
OT interventions with the teachers/staff included: provid-
I find that we have a role in community practice…We leave a
ing workshops to the school personnel (e.g., a workshop
bigger trace in the school when we participate in school life. (OT1)
about gross motor skills); sharing feedback with teachers; or
modeling strategies in class while the teachers observe. These
practical interventions were viewed positively by all students 3. Establishing and navigating collaborative relationships
in the class:
This thematic category addresses the interpersonal aspects
I think I’ve always appreciated when the professionals under- of collaborative relationships, highlighting the relational com-
stand the environment that we’re working in. When they ask plexities inherent in these interactions.
me to do certain exercises with a student, but they suggest to
try them with all students. It’s a way to get the student who (a) Interpersonal skills are necessary to collaborate and
the exercise is intended for, but they are all going to benefit. communicate effectively
Just the fact that they understand I’m not working one-on-one,
that I have 25 to 30 students in my class. (T6)
Teachers discussed the interpersonal skills needed during inter-
actions with OTs and other professionals. They emphasized the
(b) OT interventions done in collaboration promote further importance of knowing who the OT is and establishing a rela-
collaboration tionship; these were regarded as significant collaboration

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Canadian Journal of Occupational Therapy 0(0) 7

facilitators. For instance, one teacher (T6) noted that having “a The OTs considered the professional backgrounds of the
face to a name” and ensuring staff awareness of the assigned OT teachers. To further strengthen this bond of trust, they discussed
could enhance collaboration. Teachers may feel comfortable reflecting on their values, attitudes, perceptions, and understanding
and willing to approach the OT to start a conversation. of the teachers’ realities and priorities, as one OT indicated:
Additionally, the communication and delivery of information I really try to understand their reality, their stress, the academic
from a professional was deemed as important by teachers, as requirements, the team dynamic, and all that. And then to adjust
described: my expectations. (OT2).
The feedback I get from other teachers is when professionals are
coming into the class, they sometimes feel judged. There is this 4. Considerations for optimal collaboration
impression that what they’re doing may be wrong. So, I think the
wording and the communication that they use is very important. (T5)
Both groups provided suggestions and considerations
Trust was reported as paramount to feeling comfortable about collaboration and optimizing collaborative practice.
and willing to approach the OT for support. Trust was reported Three sub-themes were generated: one teacher sub-theme,
to be built after several years of working with the same OT and ‘Knowledge of the OT role’; one OT sub-theme, ‘Best practices
was stated to facilitate communication and interactions. for collaboration’; and one sub-theme common to both groups,
“Knowledge transfer format and delivery.”

(b) Relationships are central to the school OT service (a) Knowledge of the OT role

The OTs frequently emphasized the importance of building Teachers expressed certain knowledge needs, such as acquiring
a deeper understanding of the OT role, learning ‘how to flag
connections with staff and fostering relationships as initial
goals for their services. Like the teachers, they also discussed certain behaviors’ (T2) for early intervention, and understand-
interpersonal relationship skills. However, the focal point in ing the rationale for using specialized tools. One teacher
stated learning about the “practical things” that could be imple-
the OT discussion regarded these relationships as central to
their service delivery. mented by the teacher before OT intervention as lengthy wait-
OTs reported that understanding the school culture and times delay services (T2). Teachers proposed observing and
modeling an OT, where they “get to see the OT in action”
connecting to school staff as allies facilitates collaborative prac-
tices. OTs spoke about their relationships with school principals (T3), which could be helpful. This could further afford a learn-
as leaders who can guide the teamwork dynamics among staff, ing opportunity to reflect on while in context.
as described by one OT:
(b) Best practices for collaboration
The administration has a large impact. They back me up. They
understand my role and call upon me at the right time […] They The OTs voiced learning about the “best practices” and the
know if I have a say in a case. She will write to me, “I want you “little how-to’s” on how to collaborate with teachers. For
to be at the meeting”—to invite me to an intervention plan
instance, learning about school-relevant coaching skills and
[meeting] for a student. (OT1)
strategies to engage a teacher-partner who may be less inclined
The OTs also discussed the links they created with teachers— to collaborate. Optimizing communication skills, such as learn-
even caretakers. They expressed that connecting to someone ing to ask the right questions, was also indicated as an OT
familiar with the school facilitates their integration into the knowledge need. The OTs discussed the challenge of integrat-
school. The allies can be messengers, share pertinent information, ing within the school culture due to the different educational
manage cases and provide updates, support the implementation backgrounds of OTs and teachers, i.e., healthcare and educa-
of OT recommendations, and advocate the benefit of OT services tion. As one OT described:
through word-of-mouth. “To understand ‘planet education’… we have to readjust [our-
Interpersonal skills such as using appropriate, transparent, selves] because our background is very different. I find that to
and clear communication, developing a sense of trust, being adapt the language, it’s not entirely obvious.” (OT2)
curious, and having a dynamic and adaptable attitude were dis-
cussed as facilitating skills in the relationship. The OTs also (c) Knowledge transfer format and delivery
shared how teachers’ open-mindedness and communication
styles can impact the implementation of OT interventions. Regarding format, both teachers and OTs agreed that work-
They described how their role as an “expert” can evolve shops to optimize collaboration should involve OTs, teachers,
throughout the relationship: and other staff and professionals. Teachers emphasized the
We will be experts at the beginning for some. For others, we will need for active engagement in workshops, while follow-up ses-
be completely collaborative. They like not having a recipe. We sions could allow for practice, reflection, sharing feedback, and
may start off as experts because that is what they need, and after reinforcement of new learning to see “what worked well and
that, we split [roles] and adapt our position. (OT1) what didn’t” (T3). One OT suggested offering collaboration-

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8 Ianni et al.

focused learning sessions to university students in OT and edu- 2022; Missiuna et al., 2012; Rens & Joosten, 2014; Truong &
cation programs. Another OT proposed team-building exercises Hodgetts, 2017). These interventions consistently highlight the
outside of the work setting to informally foster collaborative need for increased collaboration, capacity-building, and engage-
relationships. ment of the OT in the school community and classroom context
(Clough, 2019; Lynch et al., 2023).
Concepts related to relationship-building and the interper-
Discussion sonal skills needed to navigate collaborative work were reported
This qualitative descriptive study aimed to explore the current by teachers and OTs. Feeling a sense of belonging and comfort-
and ideal collaborative practices and associated contextual bar- able in the relationship were discussed by the OTs and teachers,
riers and facilitators related to collaboration among elementary respectively. For OTs, this sense of belonging is imperative to
school teachers and school-based OTs working in southern building their professional identity as school OTs (Lamash &
Québec mainstream schools. Fogel, 2021). For teachers, our results reflected prior research
In the context of delivering occupational therapy services findings on how initiating a collaborative relationship may
in this province, a notable contrast emerged between the discus- create feelings of insecurity (e.g., fear of being judged)
sions of teachers and OTs. This highlights the diverse landscape (Benson et al., 2016; Meuser et al., 2022). The OTs reflected
of service delivery models used across different school boards on their approaches and tried to understand the teachers’ reali-
and service centers (Jasmin & Ray-Kaeser, 2021). The teachers ties, manage their expectations of teachers, ensure interventions
predominantly alluded to a traditional service delivery model in are implementable, and instill trust by initiating communication,
their schools. They perceived the OT’s main role is to adminis- similar to previous research (Benson et al., 2016; Meuser et al.,
ter individualized assessments following a referral, which may 2022; Rens & Joosten, 2014; Wintle et al., 2017). A snowball
lead to lengthy waitlists (Jasmin et al., 2019). Both groups effect seems to occur; the more OTs share responsibilities
reported that the multiple school assignments impact collabora- with teachers and work in the classroom, the deeper and
tion negatively due to the inconsistent presence of OTs in richer the collaboration becomes (Campbell et al., 2012),
school, which limits opportunities for exchanges and hinders which was expressed by both groups in our study. The partner-
the ability to provide timely services (Beaudoin et al., 2019; ship between OTs and teachers not only strengthens collabora-
Bonnard et al., 2024, Renaud et al., 2024; Rens & Joosten, tion but also expands the potential scope of school OT practice
2014). To mitigate case management and promote the OT (Casillas, 2010; Meuser et al., 2022). These interpersonal rela-
role in the school, both groups discussed the role of an “ally” tionship skills are the basis for effective communication and
to link the OT to the school. These allies (e.g., school principal, for navigating various attitudes or practice styles (Kennedy &
resource teacher, or special educator) can promote collaboration Stewart, 2011; Suter et al., 2009). Professional development
by explaining OT service mandates and including the OT in to address and enhance these skills has been recommended
meetings (Sider et al., 2017). There is little research on how (Bonnard et al., 2024; Hillier et al., 2010).
OT–teacher collaboration can be facilitated via an ally in the Regarding contextually based practice and research impli-
school. However, case management has been identified in cations for collaboration in schools, our findings highlight the
models of teamwork (Hillier et al., 2010). necessity to examine the service delivery models currently
In contrast to the teacher’s reports of a traditional model of employed in Québec. This includes clearly defining the role
service delivery, the OTs seemed to recognize the need to of school OTs and recommending models that promote
employ a more collaborative, school-wide, or multitiered optimal collaboration (Bonnard et al., 2024). For example,
approach rather than adhering to an individual, referral-based best practice guidelines have recommended adopting a work-
model (MELS, 2007). They collaborated with teachers on load approach versus a caseload approach, where services are
teacher-chosen topics (e.g., printing) or goals for class-wide predominantly provided in the classroom environment
needs. In addition, workshops, coaching or modeling-specific (Seruya & Garfinkel, 2020). Moreover, role descriptions of
techniques, and consultation meetings with teachers were school professionals and procedural guidelines, at both the pro-
viewed as beneficial to fostering collaboration. Our findings vincial and school levels, need to emphasize collaborative
further recommend, as indicated in previous literature, that teamwork (Villeneuve & Shulha, 2012). Confusion or poor
OTs who target their services at this first tier appear to facilitate understanding of the OT service mandate, what OTs do (or
access to OT services, assist with OT exposure and advocacy, can do), may influence teachers’ perceptions as well as their
and promote the understanding of the OT role (Bonnard inclination to initiate a collaborative relationship (Cahill et al.,
et al., 2024; Lynch et al. 2023). Although the teacher focus 2014; Truong & Hodgetts, 2017).
group mainly alluded to a referral-based model, these school- Furthermore, in research, key contextual ideas to inform
wide OT interventions were reportedly appreciated and the development of a tailored KT intervention on school collab-
viewed positively by teachers. They prefer to see the OT “in oration have also been identified. Both teachers and OTs agreed
action” in the classroom, to have more opportunities to exchange professional development initiatives should consider jointly
and appreciate tools or strategies that, although intended for one held sessions, where OTs, educators, professionals, and
student with special needs, could benefit all students, which has support staff can attend. Accordingly, such joint training oppor-
been previously reported (Camden et al., 2021; Meuser et al., tunities should include active engagement and reflection in KT

Canadian Journal of Occupational Therapy

Canadian Journal of Occupational Therapy 0(0) 9

sessions and mentoring, which are recommended strategies to References

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However, future research is needed to determine the extent to
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Renaud, S., Bisaillon, L., Baril, N., & Drolet, M. J. (2024). The ethical Occupational Therapy, Schools, & Early Intervention, 10(4),
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Quebec-Canada. Journal of Occupational Therapy, Schools, & Wintle, J., Krupa, T., DeLuca, C., & Cramm, H. (2022). Toward a con-
Early Intervention, 1–21. https://doi.org/10.1080/19411243.2024. ceptual framework for occupational therapist-teacher collabora-
2382720 tions. Journal of Occupational Therapy, Schools, & Early
Rens, L., & Joosten, A. (2014). Investigating the experiences in a Intervention, 15(2), 148–164. https://doi.org/10.1080/19411243.
school-based occupational therapy program to inform community- 2021.1934238
based paediatric occupational therapy practice. Australian
Occupational Therapy Journal, 61(3), 148–158. https://doi.org/ Author Biographies
10.1111/1440-1630.12093
Sandelowski, M. (2000). Whatever happened to qualitative descrip-
Lina Ianni, MSc, is a graduate student pursuing a PhD in
tion? Research in Nursing & Health, 23(4), 334–340. https://doi.
Rehabilitation Sciences at McGill University. Her research
org/10.1002/1098-240X(200008)23:4%3C334::AID-NUR9%3E3.
focus and interests lie in knowledge transfer and examining
0.CO;2-G
the organization and delivery of school-based health services.
San Martín-Rodríguez, L., Beaulieu, M.-D., D’Amour, D., & Chantal Camden, PhD, is an associate professor at Sherbrooke
Ferrada-Videla, M. (2005). The determinants of successful collab- University. She completed her postdoctoral training at
oration: A review of theoretical and empirical studies. Journal of CanChild, McMaster University, Canada, in knowledge trans-
Interprofessional Care, 19(sup1), 132–147. https://doi.org/10. fer and health services in pediatric rehabilitation. Her research
1080/13561820500082677 focuses on improving access and quality of services for children
Seruya, F. M., & Garfinkel, M. (2020). Caseload and workload: with developmental difficulties.
Current trends in school-based practice across the United States.
The American Journal of Occupational Therapy, 74(5). 1–8. Wenonah Campbell, PhD, John and Margaret Lillie Chair in
https://doi.org/10.5014/ajot.2020.039818 Childhood Disability Research, is an associate professor in
Sider, S., Maich, K., & Morvan, J. (2017). School principals and stu- McMaster University’s School of Rehabilitation Science and
dents with special education needs: Leading inclusive schools. a Scientist at CanChild. Dr. Campbell studies delivery of
Canadian Journal of Education/Revue Canadienne de health support services in schools.
L’éducation, 40(2), 1–31. https://www.jstor.org/stable/90010122/
Suter, E., Arndt, J., Arthur, N., Parboosingh, J., Taylor, E., & Heather Colquhoun, PhD, is an associate professor in the
Deutschlander, S. (2009). Role understanding and effective com- Department of Occupational Science and Occupational
munication as core competencies for collaborative practice. Therapy, University of Toronto. She received her PhD from
Journal of Interprofessional Care, 23(1), 41–51. https://doi.org/ McMaster University in Hamilton, Canada. Heather’s work
10.1080/13561820802338579 focuses on implementation science, knowledge translation,
Tétreault, S., Beaupré, P., Carrière, M., Freeman, A., & Gascon, H. patient engagement and knowledge syntheses.
(2010). Évaluation de l’implantation et des effets de l’Entente de
Dana Anaby, PhD, is an associate professor at the School of
complémentarité des services entre le réseau de la santé et des ser-
Physical and Occupational Therapy at McGill University and
vices sociaux et le réseau de l’éducation: Pour un Québec attentif
the recipient of the FRQS (Fond de Recherche-Santé)
aux élèves handicapés ou en difficulté d’adaptation ou d’apprentis-
Research Scholar Career Award. Her research focuses on devel-
sage. Centre interdisciplinaire de recherche en réadaptation et
oping and testing intervention plans to improve the participa-
intégration sociale. https://rfdi.org/index.php/1/article/view/170
tion of youth with disabilities in real-world contexts.
Truong, V., & Hodgetts, S. (2017). An exploration of teacher percep-
tions toward occupational therapy and occupational therapy prac-
tices: A scoping review. Journal of Occupational Therapy, Appendix A
Schools, & Early Intervention, 10(2), 121–136. https://doi.org/10.
1080/19411243.2017.1304840 Focus Group Questions
VanderKaay, S., Dix, L., Rivard, L., Missiuna, C., Ng, S., Pollock, N., The Theoretical Domains Framework was selected as a guiding
& Campbell, W. (2021). Tiered approaches to rehabilitation ser- framework due to its comprehensiveness and theory-informed
vices in education settings: Towards developing an explanatory approach to identifying determinants of behavior (Atkins
programme theory. International Journal of Disability, et al., 2017). Examples of questions include: environmental
Development and Education, 70(4), 540–561. https://doi.org/10. context and resources, professional role/identity, knowledge,
1080/1034912X.2021.1895975 and interpersonal skills The focus group discussion questions
Villeneuve, M. A., & Shulha, L. M. (2012). Learning together for also reflected the determinants for successful collaboration as
effective collaboration in school-based occupational therapy described by San Martín-Rodríguez et al. (2005).
practice. Canadian Journal of Occupational Therapy, 79(5), QUESTION 1: In your current situations, can you describe
293–302. https://doi.org/10.2182/CJOT.2012.79.5.5 what collaboration (with professionals or OTs) actually looks
Wintle, J., Krupa, T., Cramm, H., & DeLuca, C. (2017). A scoping like (in your own terms)? (Can you share your experiences
review of the tensions in OT–teacher collaborations. Journal of regarding collaborative practices in your own work settings?)

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12 Ianni et al.

QUESTION 2: In an ideal situation, what would optimal Journal of Occupational Therapy, Schools, & Early Intervention,
collaboration look like? Reflect on past instances where you 12(1), 51–67. https://doi.org/10.1080/19411243.2018.1512436
felt that collaboration worked very well. Describe what were Cook, L., & Friend, M. (2010). The state of the art of collaboration on
the elements that helped contribute to this. behalf of students with disabilities. Journal of Educational and
QUESTION 3: What are some resources at the organiza- Psychological Consultation, 20(1), 1–8. https://doi.org/10.1080/
tional (school environment) level that can favor collaboration 10474410903535398
in your work settings? Discuss the procedures or policies that CTREQ (2018). La collaboration entre ensignants et intervenants en
should be changed, added, or even removed to promote milieu scolaire. Ministère de l’Éducation et de l’Enseignment
optimal collaboration. supérieur (MEES). https://www.ctreq.qc.ca/wp-content/uploads/
QUESTION 4: Think about moments where you had to 2018/09/CTREQ-Projet-Savoir-Collaboration.pdf
collaborate with professionals/teachers. Can you discuss the Garfinkel, M., & Seruya, F. M. (2018). Therapists’ perceptions of the
interpersonal skills that favor collaboration? 3:1 service delivery model: A workload approach to school-based
QUESTION 5: Concerning interpersonal skills, what practice. Journal of Occupational Therapy, Schools, & Early
would you want to learn about, or change, in order to collabo- Intervention, 11(3), 273–290. https://doi.org/10.1080/19411243.
rate more effectively? 2018.1455551
QUESTION 6: Reflecting on the elements of collaboration Hanft, B., & Shepherd, J. (2016). Collaborating for student success
presented, on a scale of 1 to 10, 1 being that you do not collab- (2nd ed.). AOTA Press.
orate at all and 10 being you are an excellent collaborator, Hillier, S., Civetta, L., & Pridham, L. (2010). A systematic review of
where would you rate yourself right now? collaborative models for health and education professionals
QUESTION 7: Considering the factors to optimize collab- working in school settings and implications for training [review
oration that were mentioned earlier, what kind of information article]. Education for Health, 23(3), 393–393. http://www.
(content) will be important for you to have? educationforhealth.net/article.asp?issn=1357-6283;year=2010;
QUESTION 8: Which skills will be important for you to volume=23;issue=3;spage=393;epage=393;aulast=Hillier https://
improve or acquire to optimize collaboration? doi.org/10.4103/1357-6283.101475
QUESTION 9: Considering the factors to optimize collab- Idol, L., Paolucci-Whitcomb, P., & Nevin, A. (1995). The collabora-
oration that were mentioned earlier expand on some strategies tive consultation model. Journal of Educational and
that you think will help you [to learn or change practice Psychological Consultation, 6(4), 329–346. https://doi.org/10.
behaviors.] 1207/s1532768xjepc0604_3
QUESTION 10: Looking at this list of strategies and mech- Laverdure, P. A., & Rose, D. S. (2012). Providing educationally rele-
anisms [that the participants created], which one (or ones) do vant occupational and physical therapy services. Physical &
you think can be most impactful in learning about collaboration Occupational Therapy In Pediatrics, 32(4), 347–354. https://doi.
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that you think would work best? Missiuna, C. A., Pollock, N. A., Levac, D. E., Campbell, W. N.,
Whalen, S. D. S., Bennett, S. M., Hecimovich, C. A., Gaines,
B. R., Cairney, J., & Russell, D. J. (2012). Partnering for change:
An innovative school-based occupational therapy service delivery
Appendix B model for children with developmental coordination disorder.
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