School-based occupational therapists provide direct services, with the child removed from the classroom and integrated, and consultative services within the classroom, involving the teacher and members of the teaching staff. The purpose of this study was to determine the percentage of time that school-based therapists spend using direct/pull-out and integrative/consultative models of service delivery, to explore the attitudes of occupational therapists toward direct/pull-out and integrative/consultative services, and to identify variables associated with attitudes toward each. Written forced choice surveys were mailed to 321 school-based occupational therapists, and data analysis included 216 (67% of the sample). Therapists spent 47% of the time providing pull-out services and 53% of the time in the classroom and in consultation. Although the respondents indicated that they enjoyed one-on-one interaction with students, they disagreed that children with disabilities were best served when pulled out of the classroom. Attitudes toward consultation were positive; therapists enjoyed sharing their expertise and believed that therapy should be integrated throughout the school day. Time spent using pull-out services and consultation was highly related to attitude toward that service delivery model; therapists who provided primarily consultation were significantly lower in their ratings of the importance of direct, pull-out services. Therapists who were contracted by the school used pull-out services more than did those employed in the school (58% compared with 44%). School-based therapists appear to use a variety of service delivery models and have blended direct services with integrative/consultative services. They identified advantages to the use of both models and seem to believe that children are best served when direct services are combined with those that integrate therapy into the classroom and involve consultation with teachers.
Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review
