Date Presented 04/01/2022

This mixed-methods research study explores the effectiveness of a community-based telehealth handwriting camp to improve handwriting legibility in school-age children (ages 5-9 years). The camp was lead by an experienced OT practitioner and supported by college-level student volunteers, and it used materials from the Handwriting Without Tears curriculum. Pre- and postcamp assessments were scored by a blinded OT practitioner with more than 10 years of pediatric clinical experience.

Primary Author and Speaker: Lauren Stone Kelly

Contributing Authors: Abigail Wright

PURPOSE: Handwriting development is a major area of concern for many school-aged children and is a primary intervention area for school-based OTs [1]. Telehealth therapy is a growing area of practice, especially in pediatrics [1,2,3]. With the COVID-19 pandemic, tremendous growth in the telehealth field was observed, especially with school-based services. This study aims to build on current evidence to support ongoing use of and to expand access to OT telehealth services with pediatric populations.

DESIGN: This mixed-methods study examines the impact of a telehealth handwriting camp on legibility utilizing the Handwriting Without Tears (HWT) curriculum with children ages 5-9 entering kindergarten-3rd grade in fall 2021. There were no geographic, socioeconomic, gender, or needs based inclusion criteria for participation. Participants were granted entry on a first-come, first-serve basis up to the camp enrollment limit. The camp was provided free-of-charge during June & July 2021 with all materials provided by the PI’s institutional funding. Participants were recruited in the Chicagoland area through word-of-mouth and electronic flyers. Once registered for the camp, they were invited to join the study, though participation was not required to receive camp services. In total, 17 children registered for the camp with 16 attending. Of those, 11 consented to participate.

METHOD: Children participated in six 90-minute session based on age/grade level (Camp A: K-1st grade & Camp B: 2nd-3rd grade) including 10-15 min of 1:1 or 2:1 support at the end of each session. Camp activities utilized HWT workbooks and manipulatives and was led by a licensed OTR with 9 years of pediatric clinical experience and handwriting certification. Camp was supported by 5 (per group) college-age student volunteers. All volunteers were enrolled in a health science undergraduate program or the Master of Occupational Therapy program at North Central College. Students completed research ethics training and an online handwriting training using the Learning Without Tears Stepping Into Handwriting program. They also attended a 2-hour in-person training with the camp leader. Handwriting legibility was assessed using The Print Tool and a draw-a-person task using “Mat Man” as the prompt. The pre-test was administered virtually as a group at the beginning of the 1st session and the post-test at the end of the 6th session. After camp ended, all forms were de-identified & blindly scored by a licensed OTR with over a decade of pediatric clinical experience and handwriting certification. The blinded scorer had no involvement in camp development or implementation & was blinded to ages, grade levels and pre- or post-test status at the time of scoring. Following the camp, each child was provided an individualized recommendation form based on pre-and post-test observations. Parents/guardians were then asked to complete a follow-up survey on their experience and perceived effectiveness of the camp on their child’s handwriting.

RESULTS: Results of this study will compare pre- and post-test scores on The Print Tool as well as qualitative comparison of the pre-and post-test draw-a-person tasks to explore changes in handwriting legibility. Parental surveys will provide subjective data on the perceived effectiveness of the camp and on the meaningfulness and enjoyment of the camp.

CONCLUSIONS: While results of this study are pending, it is anticipated that outcomes will inform OTs on the feasibility and utility of telehealth-based group handwriting interventions, especially in schools and outpatient clinics. In a time when healthcare providers are relying heavily on technology, this study is expected to support the ongoing advocacy efforts to expand OT reimbursement and service provision via telehealth.


1. Grajo, L.C., Candler, C., & Sarafian, A. (2020). Interventions within the scope of occupational therapy to improve children’s academic participation: A systematic review. American Journal of Occupational Therapy, 74(2), 7402180030.

2. Robinson, M.R., Koverman, B., Becker, C., Ciancio, K.E., Fisher, G., & Saake, S. (2021). Health policy perspectives - Lessons learned from the COVID-19 pandemic: Occupational therapy on the front line. American Journal of Occupational Therapy, 75(2), 7502090010.

3. Engel, C., Lillie, K., Zurawski, S., & Travers, B.G. (2018). Curriculum-based handwriting programs: A systematic review with effect sizes. American Journal of Occupational Therapy, 72(3), 7203205010.

4. Richards, L.G., & Vallee, C. (2020). Editorial - Not just mortality and morbidity but also function: Opportunities and challenges for occupational therapy in the World Health Organization’s Rehabilitation 2030 initiative. American Journal of Occupational Therapy, 74(2), 7402070010.