Occupational Therapists in Chilean schools: their role and practices towards the inclusion of students with Special Educational Needs or disabilities.

Abstract

The inclusion of children with special educational needs or disabilities in education differs according to local contexts and the individuals involved. I explored what School-Based Occupational Therapists (SBOTs) do to address this issue, given that they are allied health professionals who facilitate the participation and performance of diverse students in school settings, particularly those with special educational needs or disabilities. Drawing on my experience as an SBOT in Chile, I examined the role and practices Chilean SBOTs play in supporting these students, as well as the factors that influence their services. Despite the growing number of SBOTs in schools of Chile over the past five years, no research about their services has been published, so little is known about their practices and contributions to inclusion. To address this gap, I considered the concept of inclusive practices — the daily actions individuals take to make inclusion meaningful. First, I conducted a scoping review of interventions provided by SBOTs, exploring which interventions have been evaluated, their components, the outcomes of occupational therapy that have been addressed, and the tiers of support utilised. There were 50 studies since 1990, the majority of which were pre/post-test studies conducted primarily with students aged five to eight years. Interventions were provided across diverse tiers of support, but most were focalized interventions administered individually or in small groups, outside of classrooms and addressing academic tasks, particularly handwriting. Then I explored the practices of Chilean SBOTs and associated factors, employing a mixed methods research design that incorporated both qualitative and quantitative methodologies. A cross-sectional survey resulted in 245 valid responses from Chilean SBOTs that were analysed using descriptive statistics. Participants predominantly provided services through individual and targeted interventions conducted in settings separate from mainstream classes, and for specific groups of students. The application of ‘universal design for learning’, which is the inclusive framework required by the Chilean government was also missing from their accounts. The factors that had an impact on these findings were explored with 18 SBOTs in four online focus groups. The practices and services of Chilean SBOTs were shaped by five factors: contextual dependence based on institutional constraints, perspectives held by the educational community, characteristics of the students, persistent demands to take a deficit-oriented approach, and the impact of the COVID-19 pandemic. I integrated these results with the scoping review and outlined the current model of SBOT provision in Chile. This was characterised by SBOTs' difficulty in developing an inclusive praxis, making it challenging for them to play an active role in fostering classroom inclusion. This contributes to the Chilean practice of initially segregating students in need of support and reflects the challenges of integrating a health service into educational settings such as schools. On the basis of these findings, I argue for change in three main areas to support inclusive practice from SBOTs in Chile (i) policy transformations, particularly regarding the inclusion of SBOTs in legislation and the creation of improved guidelines; (ii) school culture transformations, particularly regarding the development of a culture of collaboration and teamwork; and (iii) transformations from the profession of SBOTs, particularly regarding the undergraduate preparation to work in schools and the provision of professional development opportunities. If these issues are substantially addressed, only then will Chilean SBOTs may have greater opportunities to provide services that reflect inclusive practice.