Objectives. Recent literature indicates that there is an inconsistent use of theory to guide clinical actions by occupational therapists, including those working in pediatrics. The purpose of this study was to describe school-based therapists’ theory application by collecting information about what frames of reference they used and why.

Method. Of the 72 school-based therapists in the mid-Atlantic states who agreed to respond to a questionnaire, 51 (70.8%) returned the questionnaire. Information about demographics, what frames of reference were used, and why they were used was obtained from the questionnaire.

Results. Respondents reported using a multitheoretical approach, with sensory integration theory and neurodevelopmental theory being the predominate frames of reference applied but not the only ones used. The frames of reference were used on the basis of several factors, including the children’s needs and the respondent’s education.

Conclusion. Formal and continuing education seems to have a great effect on school-based occupational therapists as they develop their personal conceptual frameworks.

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