Best Practices for Supporting Occupational Therapy Students With Disabilities During Clinical Education: Results From...

Disabled occupational therapy students face systemic barriers in clinical education. Although legal mandates require reasonable accommodations, implementation is often inconsistent, and few standardized guidelines exist for fieldwork education. This study is aimed at establishing best practices for supporting occupational therapy and occupational therapy assistant students with disabilities during fieldwork.

A three-round Delphi study was conducted with a panel of 30 experts, including disabled occupational therapy students, disabled occupational therapy practitioners, academic fieldwork coordinators (AFWCs), fieldwork educators (FWEs), disability services staff, and researchers. In Round 1, participants answered open-ended questions about challenges, accommodations, and environmental supports. Responses were analyzed using conventional content analysis. In Rounds 2 and 3, participants rated the importance and feasibility of proposed practices using a 7-point Likert scale. Practices with a median importance score of ≥ 6 and an interquartile range (IQR) < 2 were considered to have reached consensus.

Forty-one best practices and 12 suggested available accommodations reached consensus for importance. The best practices were organized into six thematic categories: (1) facilitating communication, collaboration, and transparency; (2) advance planning; (3) normalizing and affirming accommodations; (4) education of key stakeholders; (5) individualized and flexible approaches; and (6) addressing structural barriers and institutional ableism.

Findings highlight the need for structured, inclusive approaches to disability accommodations in occupational therapy clinical education. Key recommendations include proactive communication, early planning, stakeholder education, and flexible implementation of supports. Many best practices emphasize cultural shifts towards disability affirmation, universal design for learning, and structural change-rather than relying solely on individualized accommodations.