OBJECTIVE

To understand the perceptions of school-based physical therapists (SBPTs) regarding their actual versus ideal practices of school-based physical therapy.

METHODS  

Participants: SBPTs, both members and non-members of the APTA, including the Section on Pediatrics, and School-based Special Interest Group (SIG). Survey: Open-ended comments were invited upon completion of an on-line survey regarding actual versus ideal practices by SBPTs (Effgen et al., 2012). 250 of the original survey’s 581 participants (45%) provided such responses. Data Collection: On-line open ended responses were typed by the respondent into Qualtrics, a web-based tool for survey research. Participant data was retained for qualitative analysis. Data analysis: Interpretive phenomenologic methods were conducted by two researchers using individual and collaborative analysis with consensus in a three step process: coding, categorizing, and developing themes. The coded data were re-organized into three categories: 1.  persons 2.  tasks 3.  environments. These categories were threaded through the commentaries to provide a representative means for rebuilding of data. Once rebuilt, the researchers resynthesized and interpreted data for emergent themes; six themes emerged. Study Rigor: Means to ensure rigor included triangulation, dual coding, peer debriefing, thick description; use of all data, and constant comparative analysis.

DISCUSSION SUMMARY The themes of the unique practices of SBPTs are themes of determination. They provide evidence of resilience, teaming, and innovation. Therapists offered diverse inputs. Some were ready to quit out of f rustrat ions they experienced, others found their districts supportive and effectual. Many who par t ic ipa ted had over 20 years experience, many were novices. Though obstacles abounded, SBPTs appear to experience successes. According to these respondents, those SBPTs who choose to stay in this practice area can meet their students’ needs, even when their efforts are built on unrelenting challenges, common frustrations, and practical uncertainties. The themes identified may prove the threads of that success.

FUTURE DIRECTIONS With support of a growing body of research, many SBPTs have initiated grass root changes in how therapy services are provided in schools, yet it appears that more needs to be done. Assistance from the APTA Section on Pediatr ics may help consol idate recommendations for: •  appropriate caseloads, •  selection of models of intervention, •  identifying requirements for SBPT

qualifications and performance appraisals.

Such professional guidance and support may help empower SBPTs, collectively and individually, to achieve more ideal practices. It may also give therapists the backing they need to better define their own practices. Thus, regardless of their district struggles, SBPTs may be ensured of best possible student outcomes.

ACKNOWLEDGEMENTS

Thank you to the SBPTs who provided their thoughts, perceptions and insights regarding their unique areas of PT practice.

This was the pre-dominant theme of most therapists, a theme that coursed through all other themes.

“ A majority of work days, I leave my job feeling as if I have not done enough to help the kids. The truth is, I have done all I can …I stay in my job because I love the kids I serve.”

Therapists described obstacles of every sort, creating a sense that meeting student needs was never taken for granted, though it was always a quest. One therapist expressed gratitude for successes:

“I am thankful that I work in local schools that are flexible and strive to meet the needs of the students most of the time.”

SBPTs appeared to develop their individual and collective professional identity over time. Early stages of trying to fit into schools were often challenging. Individual schools and districts appeared to offer unpredictable expectations/understandings of SBPT roles. Therapists sought a fit and a function for themselves regardless of the challenges and reception.

“I believe therapists here (in the school) are square pegs trying to fit in round holes.”

And yet, the synergy of team and understanding can achieve levels of success.

“The OTs and PTs in our district have worked diligently with our administrators over the past several years … (they now have) adequate staff, ability to provide input on issues affecting students, and flexibility to work with schedule weekly to meet the needs of our student caseloads.”

“Part of the reason… (I succeed in meeting student needs) ….is the long-term relationships I have established with teams.”

Building understanding: Developing a voice/identity in the school context

As part of related services, therapists sought to understand their roles as PTs and also their relatedness, relationships, and relative impact on their school team. Team members, teachers, administrators, parents, staff, and even community physical therapists were described as essential to effective practices. When considering relatedness, perceptions swung between the extremes of exclusion to strong team identities.

On the down side: the “initiative.....is always from my side.”

In healthy districts, relatedness adds to the therapist experience:

“I am a respected member of the team. I am able to be flexible about when and how I work with a student.“

Therapists reported failures and success from rationing to workload caps. The consummate view:

“Often the rules and outside structures of the therapy delivery system (of the school system) work against delivering quality care.”

Therapists try to “be creative” in the way they work, but at times cannot succeed:

“Despite creative scheduling, educating paraprofessional staff and teachers, using a "push-in" to the classroom model and other creative solutions, I am frequently frustrated that my work week is continually about juggling who I don't see that week, so I can meet the needs of another student…”

In rare cases, caseload caps are implemented. The therapist who reported implementation of caseload caps concluded that she and her district… “Know they are blessed.”

Seeking relatedness: Finding working teams in the school system as related services

Stretched beyond limits: Managing workloads

SBPT is rarely seen as a stand-alone intervention or solution for a child. A recurring theme was that community clinics and other PT services be factored into school-based efforts. This networking enhanced child potential in terms of overall student outcomes, integration into the community and transitions into adulthood.

“Parents often assumed that because therapies were provided at school, that their kids were getting all they needed. They were not.”

The conundrum of physical interventions in an educational setting was also observed:

“Students may need special exercises/activities that would be disruptive if provided in regular or PE class setting ….(needing) a more private setting.”

Networking: Coordinating physical therapy needs with clinic based providers

This was a theme of resolution, defiance, prescription, frustration, and hope. Schools were described as “complex practice settings.”

The how’s of this model appear more significant than the what’s. For example:

“In my area there seems to be a real disconnect between understanding the "Educational" model versus "Medical" model of service.”

Prescriptively, it was suggested they develop:

“more cohesiveness in… school-based services, more appropriate interventions (natural environments vs. pull-out)…no delineation between direct and indirect service.”

The model often brought frustrations to therapists:

“I hate this model, but love the kids and staff. … am looking for ways to change this model that allows for the financial constraints of the district.”

Even among pediatric specialties:

“Our OT and PT peers who work in other settings with children do not seem to understand the best practices for working in school settings.

Defying definition: What it means to SBPTs to work in an educational model

In quest: Meeting students’ school-based needs via physical therapy

EMERGENT THEMES