Examining the Current Role of OTs in Trauma-Informed Care Within School-Based Practice

PURPOSE: Exposure to early trauma significantly influences development across multiple areas, impacting children’s functional participation in daily occupations (Whiting, 2018). Schools are the primary means of access to mental health services for children, yet children with psychosocial needs are often under-serviced by school-based occupational therapy practitioners (Whiting, 2018) and not all OTs have a solid understanding of the developmental impact of trauma (Fraser et al., 2019). Currently, there is limited research on the role of school-based OTs in the implementation of trauma-informed practices within schools. Occupational therapists must remain within the forefront of school-based teams supporting children with trauma exposure. An understanding of the current knowledge and role of occupational therapists within trauma-informed practice needs to be established. Therefore, this research aims to answer the question: What are school-based occupational therapists’ perception and understanding of their role in trauma informed care?

DESIGN: An explanatory sequential mixed methods research design inclusive of an online survey and individual semi-structured interviews was followed. Participants included licensed occupational therapists and certified occupational therapy assistants currently working, at least, 15 hours per week within school-systems. Participants were recruited using random, convenience, and snowball sampling procedures.

METHOD: Participants completed a 25 question online survey in which they were asked to volunteer to partake in a 20-minute semi-structured interview at the end. A semi-structured interview consisting of 14 questions with prompts was utilized. Qualitative data was analyzed via thematic analysis. Interviews were coded and themes within were noted until saturation was met. Themes were organized, defined and named. Quantitative data was analyzed using descriptive statistics and cross-tabulated. Once analyzed, data was then triangulated to ensure validity of findings.

RESULTS: Once filtered for completeness 160 survey participants and 13 interview participants were included. The following themes emerged; building the understanding of occupational therapists’ scope of practice, rapport and therapeutic use of self, holistic and functional practice, ongoing development of school programming, and education and training. Data analysis revealed that 81% of practitioners indicated they understand the term trauma-informed care and strongly agreed that trauma impacts multiple areas of functioning throughout the school day (73%). Eighty-eight percent of respondents at least agree that OTs should be part of school-based mental health teams, 78% of participants at least agree OTs should be consulted for children who have experienced trauma, while, 53% of participants indicated that they are rarely consulted as part of this team. 67% of participants, indicated that trauma-informed practice was not included within their education program, while 88% of participants felt as though trauma-informed care should be included within occupational therapy education curriculums.

CONCLUSION: The purpose of this study was to examine the perception and understanding of school-based occupational therapists regarding their role in trauma-informed care. Within both qualitative and quantitative measures, it can be determined, that this continues to be a significant and high-interest emerging area of practice for school-based practitioners. OTs need to become advocates for the profession, to ensure growth in the understanding of the profession’s vast scope of practice within schools, and to continue growing the role of school-based practitioners in supporting children who’ve experienced early trauma.

References

Center for Disease Control and Prevention (2020-b). Preventing Child Abuse and Neglect. Retrieved July 18, 2020, from https://www.cdc.gov/violenceprevention/childabuseandneglect/fastfact.html

Fraser K., MacKenzie, D., & Versnel, J. (2019). What is the current state of occupational therapy practice with children and adolescents with complex trauma? Occupational Therapy in Mental Health, 35(4), 317-338. https://doi.org/10.1080/0164212X.2019.165132

Purtle, J., & Lewis, M. (2017). Mapping “Trauma-informed” legislative proposals in U.S. congress. Administration and Policy in Mental Health and Mental Health Services Research, 44(6), 867-876. https://doi.org/10.1007/s10488-017-0799-9

Whiting, C.C. (2018). Trauma and the role of the school-based occupational therapist. Journal of Occupational Therapy, Schools & Early Intervention, 11(3), 291-301. https://doi.org/10.1080/19411243.2018.1438327