Variables Related to Successful School-Based Practice

Abstract

In this ethnographic study, 13 occupational therapists who provided school-based services were interviewed. Each therapist was asked to describe an example of a student with whom she felt particularly successful and one who was challenging or frustrating. Three themes were identified in the examples through analysis that included a follow-up focus group meeting of the participants. The frame of clinical reasoning was applied to help interpret the results. Procedural reasoning was described as “Finding the key” by the participants. This theme defined their search for the underlying reasons for the child's behaviors and performance. The key, or a way to reframe the child's behaviors, then became the basis for their intervention activities and was shared with teachers, parents, and other team members. Finding the key seemed to be particularly important to helping the team design an appropriate environment-child fit that enabled the child's best performance. The second theme, “The whole child,” emphasized the importance of the child's psychosocial core and described the therapist's use of interactive and conditional reasoning to support the student's selfimage. Because the therapists valued the child's vision of a new self, they were able to help the child achieve new social roles and improved selfesteem. A third theme, “Whose success is this?,” told of the importance of a cohesive team, which included the parents, to the success of the child. The child's achievement of important life goals and success as a student seemed to be the result of a team effort to which occupational therapy contributed. Cohesive and collaborative teams seemed to be instrumental to the child's progress and goal attainment.