Evidence for Implementing Tiered Approaches in School-Based Occupational Therapy in Elementary Schools: A Scoping Review

Importance: Internationally, it is suggested that school-based occupational therapy (SBOT) has an important role in supporting inclusion in educational settings. In SBOT, multitiered service delivery models are identified as a way forward to maximize school inclusion. Therefore, identifying evidence for the implementation of tiered interventions in SBOT is vital. Objective: To identify and map evidence in the occupational therapy literature relating to SBOT interventions delivered in elementary schools for all children, for those at risk, and for those with identified diagnoses. Data Sources: Peer-reviewed literature published in 14 occupational therapy journals between 1990 and 2020, indexed in the EBSCOhost database. Study Selection and Data Collection: Included studies were those within the scope of SBOT that reported on school occupations and focused on elementary school-age children (excluding kindergarteners or preschoolers). Findings: Forty studies met the criteria. Individual-tier intervention studies (n = 22) primarily reported direct interventions with children at risk or with identified diagnoses (Tier 2 or Tier 3), focusing mostly on remedial approaches. None adopted a whole-school approach. Despite handwriting and self-regulation being dominant areas of concern, these studies were not explicitly related to inclusion outcomes. Evidence for implementing multitiered models primarily used indirect, collaborative consultation, embedded in the school context (n = 18). These studies identified positive school staff and child outcomes when collaboration was timely, consistent, and authentic. Conclusions and Relevance: More rigorous individual-tier intervention studies are required to inform the design and implementation of multitiered interventions in SBOT and to support participation and inclusion in schools.