Conceptualizing school based occupational therapy for Malta: enabling children’s participation in school occupations through collaboration in early years settings

This thesis explores occupation, participation and occupational therapy schoolbased practice in an early years school setting. It adopts a rights-based approach
\nthat acknowledges the human and moral rights of all children to be educated; a
\nstrengths-based philosophy that moves away from an impairment focus, recognising
\nthe centrality of children, their occupations and the transactions between the
\nstakeholders within the school environment. The main research questions were:
\nWhat are the occupations that children in Maltese early-years classrooms are
\nparticipating in? What are the enablers and barriers to children’s participation in
\nschool occupations in Maltese early-years classrooms? How can occupational
\ntherapy involvement in early-years classrooms contribute to children’s participation
\nin school occupations? The arena was investigated through a qualitative paradigm,
\na longitudinal instrumental case study with elements of action theory. It was carried
\nout in one selected primary mainstream state school and involved the participation
\nof children and parents, with the educators being the main focus of this study
\nThis was a two-phased study with participation at the core of the conceptual
\nframework underpinned by Occupational Science and had 3 pillars: The first
\nexploratory part of the study was underpinned by concepts from Bio-ecological
\nSystems Theory (Bronfenbrenner, 2007). The second intervention part of the study
\nwas framed within the Social Model of Disability (Oliver, 1998), and the Canadian
\nModel of Occupational Performance – Engagement (Townsend & Polatajko, 2013).
\nThe data was analysed for its content and through thematic analysis (Braun &
\nClarke, 2013). The data were collected over a period of one school year through the
\nresearcher’s weekly presence in the school. Methods used to obtain data included
\nobservation, interviews, focus groups. Such data was supplemented with other
\ndocumentary evidence: intervention logs, a reflective journal and research diary, and
\ndiscussions with critical friends, children’s photos, school development plans, e mail
\ncorrespondence and other recorded feedback.
\nvii
\nThe findings of this study identified the social environment as key to
\nsupporting young children’s occupations through connectedness, regular, consistent
\npresence and involvement of occupational therapy in the school, the building of
\nrelationships and trust, attitudinal factors and knowledge translation between adults:
\ntherapist and educators. The importance of play especially physical play, choice, fun
\nand movement in daily routines and children’s engagement with peers and
\neducators were also outcomes of the study. The centrality of educator and parental
\ninvolvement through active engagement, were additional significant findings. The
\nimportance of Tier 1 intervention to build educators resilience in delivering their
\ncurriculum was identified whilst Tier 2 intervention provided a way forward in
\nsupporting children with ”hidden” needs. The uniqueness of Tier 3 was namely the
\ncollaboration between the occupational therapist and class teacher in the education
\nof students with a statement of needs. The primary importance of working with
\nschool leadership was a novel and important finding in this study. Inter-professional
\nworking and education, as well as student education and training, were also
\nidentified as essential for collaborative consultation to be effective in early years
\nsettings.
\nThis research contributes to the international body of evidence on
\ncollaborative consultation and also provides recommendations as to how a model of
\nschool-based occupational therapy tiered intervention for Malta, can be
\nimplemented in Maltese schools, specifically in the early years. In this respect it is
\nalso unique as no other projects or studies have ever addressed this topic in Malta.
\nFinally, this study suggests the way forward in developing school - centred practice
\nto support the participation and inclusion for all children in school and society.

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