Service Delivery Models and Barriers to Inclusion: A Mixed-Methods Study of Occupational Therapy in Chilean Schools

Area of Science:

• Occupational therapy
• Educational psychology
• Inclusion studies

Background:

• Occupational therapy (OT) services in schools are crucial for student development.
• Understanding current OT service models and their alignment with inclusive education is essential.
• Chilean schools present a unique context for examining OT practices.

Purpose of the Study:

• To identify occupational therapy service models in Chilean schools.
• To explore factors influencing these models.
• To assess alignment with inclusive practices.

Main Methods:

• Mixed-methods approach combining a cross-sectional survey (241 responses) and online focus groups (18 participants).
• Survey data analyzed using descriptive statistics.
• Focus group discussions analyzed thematically.

Main Results:

• Direct pull-out services were common (68.3%), typically weekly 45-minute sessions in OT or mainstream classrooms.
• Key influencing factors included institutional constraints, educational community perspectives, student characteristics, a deficit-based approach demand, and COVID-19 pandemic impact.
• The predominant service model showed challenges in aligning with inclusive practices.

Conclusions:

• Occupational therapy service models in Chilean schools struggle to align with inclusive practices.
• The current praxis maintains a strong medical focus, resembling clinical practice.
• This medical orientation impedes the development of truly inclusive school-based OT services.