With the passage of the "No Child Left Behind" legislation in 2001, Congress enacted comprehensive revisions to the Elementary and Secondary Education Act of 1965, which increased accountability for the learning outcomes of students. In 2004, the Individuals with Disabilities Education Improvement Act was reauthorized requiring school teams to continually assess all student learning to ensure ongoing progress in the general education curriculum and to safeguard client-centered and performance-based interventions that promote lifestyle sustainability and community participation. Over the past decade, these historic acts have brought about sweeping changes in the provision of occupational and physical therapy services in school settings, expanding the opportunities for therapy practitioners to meet the diverse needs of all students while simultaneously holding us increasingly accountable for student learning outcomes. Providing educationally relevant services has become paramount to our work as occupational and physical therapists with students, their families, and school teams.As defined in the Individuals with Disabilities Education Improvement Act, occupational and physical therapists provide services to support students to access, participate, and progress in their educational program within the least restrictive educational environment. Educationally relevant occupational and physical therapy services in school settings is characterized by its unique focus on the early identification of and intervention for students in need of learning, behavioral and functional supports to maximize skills that enable lifestyle sustainability and community participation after high school. Educationally relevant interventions must support learning and participation in the classroom and children in their role as a student learner. Furthermore, therapists must keep in mind that educational relevance will change over time based on the needs of the student and school and learning contexts. Though legislative mandates do not stipulate the types and focus of occupational and physical therapy interventions to be used to ensure student success, the legislative mandates have impacted the ways that school teams work with students and families.
Importance: The findings support the use of occupation- and activity-based interventions to improve the occupational participation of children and youth with disabilities. Objective: To examine the effectiveness of occupation- and activity-based interventions to improve participation and performance in activities of daily living (ADLs), play, and leisure in children and youth. Data Sources: MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane Database of Systematic Reviews; reference lists of retrieved articles; and tables of contents of selected journals were searched to identify peer-reviewed studies published between 2000 and 2017. Study Selection and Data Collection: Studies addressing occupation- and activity-based interventions and outcomes for children ages 5 to 21 were selected and appraised using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines, evaluated for risk of bias, and synthesized to develop practice recommendations. Findings: Fifteen Level I (meta-analyses, systematic reviews, and randomized controlled trials), 5 Level II (two groups, nonrandomized), and 3 Level III (one group, pretest–posttest, retrospective) studies were examined and categorized by type of intervention and outcome. Each study used occupation- or activity-based interventions and reported ADL, play, or leisure outcomes. Intervention themes identified include supporting engagement in occupations, supporting participation with cognitive supports, and using technology to support occupational participation and performance. Conclusions and Relevance: Strong evidence indicates that engagement in occupations and activities, practice within and across environments, and coaching and feedback improve participation and performance in ADLs and functional mobility. Moderate evidence supports the use of collaborative goal setting, modeling, and guided participation in play and leisure. Moderate evidence also supports technological interventions for ADL, play, and leisure performance. What This Article Adds: Engaging children and youth in occupations and activities; providing guidance in goal direction, planning, and feedback to enhance their participation; coaching caregivers in effective carryover; and providing technology-based intervention can improve the occupational participation and performance of children and youth.
Importance: Practitioners seek evidence from intervention effectiveness studies to provide best-practice services for children. Objective: To examine the effectiveness of occupation- and activity-based interventions to improve instrumental activities of daily living (IADLs) and sleep outcomes for children and youth ages 5–21 yr. Data Sources: MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane Database of Systematic Reviews. Study Selection and Data Collection: The American Occupational Therapy Association research methodologist conducted the first review of literature published from 2000 to 2017. The results were exported, and we completed the subsequent stages of review. Only peer-reviewed Level I, II, and III evidence was reviewed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane risk-of-bias guidelines were used to compile evidence and risk-of-bias tables. Findings: We reviewed 96 articles; 28 studies met the inclusion criteria for IADL and rest–sleep outcomes. Analysis resulted in several themes: rest–sleep, health management (nutrition–dietary, physical activity–fitness, wellness), and the IADLs of driving, communication management, and safety. Strong evidence exists for interventions embedded in school programming to improve physical activity and fitness and for sleep preparation activities to maximize quality of rest and sleep. Moderate-strength evidence exists for interactive education and skills training interventions to improve health routines, dietary behaviors, and IADL participation and performance. Conclusions and Relevance: Use of skills-focused training in activity- and occupation-based interventions was supported. Service provision in the context of natural environments, including school settings and with parental or caregiver participation, is recommended for children and youth ages 5–21 yr with varied abilities and diagnoses. What This Article Adds: Occupational therapy practitioners can confidently examine their current practices and choose activity- and occupation-based interventions and methods of service delivery that are supported by evidence.
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