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 that acknowledges the human and moral rights of all children to be educated; a strengths-based philosophy that moves away from an impairment focus, recognising the centrality of children, their occupations and the transactions between the stakeholders within the school environment. The main research questions were: What are the occupations that children in Maltese early-years classrooms are participating in? What are the enablers and barriers to children’s participation in school occupations in Maltese early-years classrooms? How can occupational therapy involvement in early-years classrooms contribute to children’s participation in school occupations? The arena was investigated through a qualitative paradigm, a longitudinal instrumental case study with elements of action theory. It was carried out in one selected primary mainstream state school and involved the participation of children and parents, with the educators being the main focus of this study This was a two-phased study with participation at the core of the conceptual framework underpinned by Occupational Science and had 3 pillars: The first exploratory part of the study was underpinned by concepts from Bio-ecological Systems Theory (Bronfenbrenner, 2007). The second intervention part of the study was framed within the Social Model of Disability (Oliver, 1998), and the Canadian Model of Occupational Performance – Engagement (Townsend & Polatajko, 2013). The data was analysed for its content and through thematic analysis (Braun & Clarke, 2013). The data were collected over a period of one school year through the researcher’s weekly presence in the school. Methods used to obtain data included observation, interviews, focus groups. Such data was supplemented with other documentary evidence: intervention logs, a reflective journal and research diary, and discussions with critical friends, children’s photos, school development plans, e mail correspondence and other recorded feedback. vii The findings of this study identified the social environment as key to supporting young children’s occupations through connectedness, regular, consistent presence and involvement of occupational therapy in the school, the building of relationships and trust, attitudinal factors and knowledge translation between adults: therapist and educators. The importance of play especially physical play, choice, fun and movement in daily routines and children’s engagement with peers and educators were also outcomes of the study. The centrality of educator and parental involvement through active engagement, were additional significant findings. The importance of Tier 1 intervention to build educators resilience in delivering their curriculum was identified whilst Tier 2 intervention provided a way forward in supporting children with ”hidden” needs. The uniqueness of Tier 3 was namely the collaboration between the occupational therapist and class teacher in the education of students with a statement of needs. The primary importance of working with school leadership was a novel and important finding in this study. Inter-professional working and education, as well as student education and training, were also identified as essential for collaborative consultation to be effective in early years settings. This research contributes to the international body of evidence on collaborative consultation and also provides recommendations as to how a model of school-based occupational therapy tiered intervention for Malta, can be implemented in Maltese schools, specifically in the early years. In this respect it is also unique as no other projects or studies have ever addressed this topic in Malta. Finally, this study suggests the way forward in developing school - centred practice to support the participation and inclusion for all children in school and society.

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