Practice evaluation
Occupational therapy in mainstream primary
schools: an evaluation of a pilot project
Eve Hutton
Key words:
Evaluation,
occupational therapy,
mainstream schools,
inclusion.
Correspondence to: Dr Eve Hutton,
Senior Lecturer, Canterbury Christ
Church University, North Holmes Road,
Canterbury, Kent CT1 1QU.
Email: eve.hutton@canterbury.ac.uk
Reference: Hutton E (2009) Occupational
therapy in mainstream primary schools: an
evaluation of a pilot project. British Journal
of Occupational Therapy, 72(7), 308-313.
© The College of Occupational Therapists Ltd.
Submitted: 16 August 2007.
Accepted: 8 April 2009.
308 British Journal of Occupational Therapy July 2009 72(7)
This article describes the outcome of an evaluation of a paediatric occupational
therapy intervention piloted in two primary schools in East Kent. Two therapists
were based in schools and worked in partnership with teachers and teaching
assistants (TAs). They spent the equivalent of 2 days a week in the school,
with the aim of increasing the knowledge and skills of teachers and TAs in
the engagement and participation of children in a range of school-based
occupations. Interviews with the teaching team carried out at the conclusion
of the intervention explored the impact on the knowledge and skills of the
school staff and the quality of the children’s school experience.
The positive response of the schools has led to the development of a bank
of occupational therapy resources for primary schools. The work associated
with the development of the resources has been supported by a 2008
Training Development Agency for schools Research and Development Award.
The possibilities of extending this approach are explored.
Background
The Children Act (2004) created a legislative framework to ensure that
all services work together to protect children and enable them to reach
their potential. Services for children, provided by health, education and
social care in the United Kingdom, are being reconfigured as the
recommendations of Every Child Matters are implemented (Scottish
Executive 2001, Department for Education and Skills [DfES] 2004,
Department of Health 2004, Welsh Assembly 2005). Schools must rise to
the challenge of being at the ‘epicentre’ of community health and
education resources, with responsibility for supporting children and
families 365 days a year (Reid 2005). The Government’s stated intention
that by 2010 extended schools will offer a range of services, including
swift and easy access to specialist support, has prompted therapists
to explore new ways of working with schools that deliver flexible
and family-orientated services (DfES 2005). There are several examples
of successful partnership working between health and education,
particularly in relation to promoting communication and the development
of language skills in early years. Initiatives such as Sure Start established
speech and language therapists as key partners with education.
Evaluations of these services have generated greater understanding about
the benefits of partnership working, but there is less knowledge about
which models of intervention work most effectively (Barber 2002).
Occupational therapy in mainstream schools
The occupational therapy service that carried out this evaluation offers
direct intervention for children attending mainstream primary schools
with mild to moderate coordination difficulties and generalised delay.
An individual child is referred to the service, assessed and then offered either
individual or group intervention, with advice and support provided direct
to families and schools (Dunn 2000). Prior to the pilot project, the

numbers of children referred to the service had increased,
leading to longer wait times, and this had resulted in
stricter referral criteria. Schools at the same time had to
meet the needs of an increasingly diverse group of
children with a wide range of developmental and health-
related difficulties and disabilities (Glashan et al 2004).
These numbers are set to rise as more children are
educated in mainstream schools as a result of an inclusive
educational policy (Special Educational Needs and
Disability Discrimination Act 2001).
In 2004, a service review considered how to meet
increased demand for occupational therapy from
mainstream schools. An option was to trial a model of
service intervention, which had already been piloted
successfully in pre-school settings in the area. SPARKLE
is a multiagency early intervention inclusion initiative
developed in 2001 in Mid Kent. A team of therapists and
a specialist teacher base themselves for a short period
in early years settings (EYS s) and work closely with
early years practitioners (EYPs), with the aim of a greater
understanding of how to promote children’s development.
The team of therapists (occupational therapists,
physiotherapists and speech and language therapists) and
specialist teachers provide targeted training and coaching
in the setting on how to promote children’s communication
and interaction, motor development and play. Through the
active sharing of knowledge and skills with EYPs, the aim
is to create EYSs that are better resourced to meet the
needs of all young children.
Occupational Therapy into Schools
(OTiS) intervention
Based on the SPARKLE model, the occupational therapy team
devised an intervention which they named Occupational
Therapy into Schools (OTiS). The aim was to provide
occupational therapy within a whole school in contrast to
providing targeted intervention for individual children.
Therapists would work alongside teachers and teaching
assistants (TAs), providing situated learning opportunities
for them within the school. The two therapists were
allocated an individual school and visited that school
regularly over a two-term period, spending the equivalent
of 2 days a week there. This enabled them to become part
of the school team and to get to know the school routines,
while the time-limited nature of the intervention was
intended to give focus to the intervention and maintain
the motivation and interest of the school team.
The intervention was tailored to the needs of the
school: the goals identified in both schools focused on
increasing the engagement and participation of all children
in a range of school-based activities. This included
writing, colouring, cutting, using cutlery at mealtimes and
participating in physical activities. The therapists also
assisted the school staff responsible for delivering a locally
developed motor coordination programme named FIZZY
(Eastern and Coastal Kent Primary Care Trust FIZZY
programme n.d.)
Eve Hutton
The therapists were both senior children’s therapists with
wide experience gained in the community. As a consequence
of delivering the intervention, both therapists reflected
on their own learning as they adopted an uncertain and
negotiated role within the mainstream school, and became,
for a short period, a part of the school team. An exploration
of the reflective learning that took place and the impact
of new ways of working on the therapists can be found
elsewhere (Hutton 2008). This report focuses on the
evaluation of the intervention from the schools’ perspective.
Method
Formal evaluation is defined as ‘a form of “disciplined inquiry”
(Lincoln and Guba 1986: 550) that applies scientific
procedures to the collection and analysis of information
about the content, structure and outcomes of programmes,
projects and planned interventions’ (Clarke and Dawson
2003, p1). Where evaluation differs from other types of
inquiry lies in its ‘ability to inform decisions, clarify
options, reduce uncertainties and provide information’
(Clarke and Dawson 2003). Evaluations are often planned,
as in this case, to take advantage of an evolving situation
and, therefore, the skilled evaluator is required to be
‘situationally responsive’.
The aim was to explore the impact that the therapists
had on the knowledge and skills of the teaching team and
to determine the schools’ views about the structure and
timing of the intervention. It was decided that qualitative
interview data gathered from individuals that came into
direct contact with the therapists during the intervention
would provide insight into their views and inform the
evaluation (Fielding 1994).
Pilot sites
Following a short presentation to the local school cluster
leads, describing the aims of the intervention, primary
schools were invited to participate in the pilot project.
Several schools volunteered and the lead education officer
identified two schools from the special educational needs
audit. Following consultation with the lead therapist, it was
agreed that both schools would provide an opportunity to
explore the impact of the intervention in an area of social
deprivation. It was thought likely that the families of
children with occupational therapy needs attending these
schools may be less likely to pursue a referral. Contact
was made with the head teacher and permissions sought
in line with ethical guidelines.
Ethical approval
The study was submitted for peer review and ethical
scrutiny to Canterbury Christ Church University Faculty
of Health and Social Care Research Ethics Committee. As
the study involved interviewing employees of the Local
Education Authority, approval was also gained from Kent
County Council Research Governance Committee.
British Journal of Occupational Therapy July 2009 72(7) 309
Occupational therapy in mainstream primary schools: an evaluation of a pilot project
Table 1. Examples of the type of goals negotiated at the outset of the project
Goals at school 1
FIZZY groups established
Increase staff understanding of child motor and sensory development
Introduce staff to strategies that will encourage children’s participation
Practical creative workshops for children and their families
Data collection
Individual and group interviews were used to gather the
views of the teaching team at both schools. A semi-structured
interview schedule was used for the interviews, which
enabled flexibility within a predetermined structure
to probe for details and discuss issues as they arose in
more depth (Fielding 1994). Individual interviews lasted
approximately 45 minutes and group interviews 60-90
minutes. Interviews and group interviews were arranged
opportunistically to fit in with the school timetable. The
interview schedule focused on the three stages of the
intervention:
1. The expectations of both teaching teams, including
prior knowledge of and experience of occupational
therapy
2. The outcomes of the project from the teaching teams’
perspective and their views of the impact of the
intervention on teaching methods
3. The teaching teams’ thoughts about the closing of the
project and whether the schools would sustain
initiatives once the intervention was completed.
Data were gathered from both schools when the pilot
project was completed in May 2007. The author, together
with an experienced researcher and colleague from the
Department of Allied Health Professions at Canterbury
Christ Church University, carried out the interviews. The
therapists identified teachers and TAs with whom they
had worked closely over the duration of the intervention
to participate in the interviews. Head teachers were
interviewed separately from teachers and TAs. In total,
interviews with the two head teachers, two special
educational needs coordinators (SENCOs), six class
teachers and eight TAs were conducted over a 3-week
period during May and June 2007.
Analysis
All the interviews were tape recorded and transcribed by
the author. Detailed notes were taken during the interviews
by the co-facilitator. Data were first coded by hand, using
codes developed with the therapy team involved.
Following this, initial analysis of the interview transcripts
and the contemporaneous notes were undertaken by the
author with the aim of identifying (1) what impact the
presence of the therapists in the schools had on the
knowledge and skills of the teaching team and (2) to gain
insight into how the service had been received by the
school team, its expectations, and its views on the
structure of the intervention.
310 British Journal of Occupational Therapy July 2009 72(7)
Goals at school 2
Work with school council to identify area of change in school environment
Workshops with children to explore and improve their school experience
Provide new resource box on scissor skill development and training
Parent advice sheets on motor skills and link with classroom skills
A matrix assisted in the organisation and presentation
of the data, which reflected the aims of the evaluation
(Miles and Huberman 1994). The emerging interpretation
of the data was shared during meetings with the occupational
therapists involved and with the co-facilitator of the
interviews to check the accuracy of the interpretation and
analysis (Silverman 2006). For the purposes of this report,
the key findings are presented as a collective response
from both schools to the intervention and categorised into
(1) notable outcomes of the intervention and (2) the
content and structure of the intervention.
Findings
Outcomes of the intervention
The teachers and TAs were invited to describe what they
felt were the notable outcomes of the intervention. The
positive comments cited below provide an insight into the
influence therapists had on the teaching team. Comments
from the team provide an indication of how regular
contact with the therapists, particularly through the
sharing of knowledge and skills, brought about actual
changes in teaching practice and the subsequent impact
that this had on children’s learning and engagement:
Incredibly motivating – one of the best things we have done
(Head teacher).
I have learnt more in two terms than I ever did at college,
or in my 26 years of teaching (Head of early years).
We have seen benefits in terms of improved handwriting,
more relaxed sitting and fidgeting has become less of a
problem in the classroom (Trainee teacher).
Implementing motor coordination programmes
in the schools
During the intervention, the therapists assisted the teaching
team in running a motor coordination programme called
FIZZY, developed by occupational therapists and
physiotherapists in the locality (Eastern and Coastal Kent
Primary Care Trust FIZZY programme n.d.). Although the
take-up of FIZZY by schools had been positive, it was
thought that the effectiveness of the programme was
limited because the teachers and TAs did not fully
understand how the programmes worked. In both of the
schools involved in the intervention, the FIZZY programme
had become ‘stale’ and both TAs and children had lost
motivation and direction.

The evaluation highlighted that the SENCOs had
attended training sessions on the programmes but that the
TAs responsible for delivering the programme were given
information by SENCOs and not directly by therapists.
This resulted in limited appreciation by them of the under-
lying principles of the programme. The TAs said that they
did not know how to identify children who would benefit
from the programmes or how to move children on through
the programme once they had made progress. During the
intervention, the therapist demonstrated how the programme
worked and encouraged staff to try out the activities
themselves. Because the therapists were on hand in the
school, the TAs had opportunities to ask for clarification
and discuss issues relevant to their particular school and
the children with whom they were working.
At the conclusion of the intervention, the TAs felt that
they had a greater understanding of the programme. In
two terms, one TA suggested that she had seen most
children make progress, which had been motivating for
both children and the staff. Importantly, one TA said that
as a result of the intervention ‘the children also know why
they are doing FIZZY’:
We had a boy who used to raise his hands in defence if we threw
a ball for him to catch – he is now catching and playing football
in the playground with his friends in the playground (TA).
Children look forward to the sessions whereas they don’t
with the exercise programme or keep fit – it’s fun and the
children enjoy it. It’s FIZZY time (TA).
‘Good’ sitting
The intervention highlighted significant gaps in both
novice and experienced teachers’ understanding of a
child’s motor and sensory development and how this may
have an impact on a child’s learning and engagement. In
one school, the issue of ‘good sitting’ had become a
particular focus of classroom tension. Young children in
reception class were asked to sit cross-legged on the floor or
upright on chairs, as part of ‘good’ classroom management.
The therapists explained why young children may not
have the ability to sit for long periods and should be
allowed to adopt a comfortable position appropriate to
their level of development and individual need. The therapists
introduced a range of resources into the classrooms for
teachers to try, including move ‘n’ sit cushions and simple
wedges and supports.
The teachers were at first apprehensive about allowing
children to sit with legs outstretched or on heels or to lie
on their tummies; one teacher said that it felt like ‘going
against the grain’. However, the impact of this advice had
been a greater appreciation by teachers of the importance
of allowing different sitting positions in the class: ‘We
are more mindful of sitting,’ said one class teacher. The
result was a relaxed atmosphere in the class, and one
more focused on learning rather than managing the
children’s behaviour:
Eve Hutton
Children don’t have to be sitting still looking at the teacher
to be learning – this has been a revelation (Head teacher).
There were ripples throughout the staff of ‘I never knew that’
(Head of early years).
One teacher described how the therapist had worked with
her on promoting the development of pencil skills with her
in her class. The therapist’s explanation of the development
of pencil control and the prerequisite skills required in
handwriting had influenced her approach to the teaching
of handwriting. The teacher commented on how the
therapist had come in with ‘lots of ideas’ and resources.
The therapist offered to lead a session in the class,
affording the opportunity for the teacher to observe her
practice; she commented that this was by far ‘the best way
to learn’.
Content and structure of the intervention
The teachers and TAs were asked to share their views
about the structure, content and timing of the intervention.
The project team members wanted to determine how
important having time to build relationships was to the
success of the intervention. Because the intervention was
short term, they wondered how the timing and length of
the intervention was received by the schools. They were
also interested to find out what the teachers’ expectations
of the intervention had been and whether these expectations
had been met.
Expectations
Several teachers commented that prior to the intervention
they had been used to therapists removing children from
the classroom and interrupting their learning. ‘Can we
borrow your child?’ was the phrase used by one teacher to
describe his earlier experiences of therapists visiting the
school setting. In one school the TAs said that previously
they had been ‘given a list of things to do’ by a therapist,
implying that there had been insufficient support to help
them implement these recommendations.
A few TAs had little or no prior experience of occupational
therapy and, therefore, had few expectations. Several teachers
mentioned how surprised they had been at the scope of the
therapists’ work and how many areas of the school routines
and curriculum they were able to influence during the
short time of the intervention.
Becoming part of the school team
The success of the intervention appeared to rest on the
development of close working relationships. It was
apparent that personal relationships and trust facilitated
the sharing of knowledge, advice and ideas. The teachers
and TAs in the interviews said that they felt ‘listened to’ by
the therapists. This was in contrast to the therapists, who
visited the school on a consultation basis when there was
often insufficient time to talk through issues or when the
teacher was engaged in other duties. When teachers had
concerns about children, they said that they were able to
British Journal of Occupational Therapy July 2009 72(7) 311
Occupational therapy in mainstream primary schools: an evaluation of a pilot project
talk through these concerns with the therapist present
and, as a result, felt more confident in their own ability to
recognise and identify children who needed additional
support. Some of this confidence had grown out of
reassurance provided by therapists that ‘You are doing the
right thing’ (Teacher).
Adjectives used to describe the therapists by those
who came into contact with them were ‘approachable’,
‘warm’, ‘flexible’ and ‘working as an equal’. One TA said
that she ‘never felt ashamed to ask a question’. The
therapists were aware of wanting to be accepted as part of
the school even if this meant ‘washing down tables after
lunch time’ (Therapist).
Timing of the intervention
The intervention was designed to achieve a set number
of targeted occupational therapy goals over a relatively
short period of time using limited resources. It was hoped
that a short-term initiative would assist in therapists
gaining the interest and motivation of the teaching team
and this appeared to be the case. Those teachers and
TAs that came into contact with the therapists mentioned
that they wanted to ‘make the most’ of the therapist while
she was there:
We got out of it what we wanted to achieve, however we
would have liked her a little longer (SENCO).
Both head teachers said that they would have preferred
a longer intervention: they felt that although the therapists
had built strong relationships with the teaching team,
more time was needed to build trust with parents and
families. One school felt that it had not had time to see the
effect of the changes fully. However, both expressed
confidence in their ability to carry on with the initiatives
that the therapists had started. Referring to the running of
the FIZZY coordination programme, one TA said:
I could do with the therapists coming back – but I feel more
confident in myself and the children sense this (TA).
Discussion
The positive response of the schools suggests that there
is scope to develop occupational therapy in schools based
on a model that promotes the active sharing of therapy
knowledge and skills with teachers, Establishing trust and
relationships appeared to be central to the success of the
initiative. The therapists also gained a great deal from the
experience, reflecting on the need to consider carefully the
demands on teachers and the school environment when
developing therapy interventions. Both therapists and
teachers gained a greater understanding and respect for
one another’s work. These relationships took time to
develop and it was only through therapists being based in
the schools rather than just visiting that relationships,
which have extended beyond the intervention, have been
established. Two school terms may not, however, be sufficient
312 British Journal of Occupational Therapy July 2009 72(7)
for schools to see the benefits and effects of change or for
therapists to develop relationships with families.
It was apparent that significant changes in several
individual teachers’ practice had occurred. This had been
achieved as a result of the situated nature of the intervention,
enabling teachers to apply new knowledge in situations
that were familiar and with children with whom they worked
on a daily basis (Prosser and Trigwell 1999). There is a
need to understand more about how situated learning
opportunities appear to provide a more powerful and
potentially transformative learning experience for those
involved (Lave and Wenger 1991).
The impetus for this evaluation originated from an
attempt to find a solution to increased referrals from
mainstream schools and from a desire to improve the
service to children and families who, for social reasons, may
find it hard to access occupational therapy. Although there
has been no firm commitment from education to support
the development of this specific model of intervention in
mainstream schools in the locality, the pilot has generated
interest amongst education colleagues. As Local Children’s
Partnerships become established, possibilities for extending
the initiative look promising (Walker 2008). The team that
piloted the intervention in 2007 is now organised into a
multidisciplinary team around the child, offering scope to
develop a multidisciplinary approach to include physiotherapy
and speech and language therapy.
One positive outcome emerging from the pilot project
has been the development of a bank of multidisciplinary
movement and coordination resources for mainstream
schools, which are currently in the process of being trialled
in mainstream primary schools in Kent as part of a 2008
Training Development Agency for schools Research and
Development Award (www.tda.gov.uk). A steering committee
for this Training Development Agency project has brought
education and health colleagues together from practice
and higher education, with the shared aim of creating learning
opportunities for initial teacher trainers and continuing
professional development for teachers. These resources are
intended to support professional understanding of the
development of children’s motor and sensory skills. The
results of the research will be disseminated widely through
health and education channels in 2009.
In conclusion, the intervention has highlighted the
need to achieve a balance between managing increased
demands on the service through stricter referral criteria
and reaching socially disadvantaged children and families.
The intervention provided in the schools highlighted that
many of the children with whom therapists came into
contact and who benefited from occupational therapy input
would have been unlikely to attend clinic appointments,
meet referral criteria or gain access to therapy other than
through the resources provided by school.
Limitations of the evaluation
This was a small-scale evaluation and, therefore, it is difficult
to generalise the findings to other services or other areas.

The evaluation gathered the views of the teachers, teaching
assistants and therapists involved in the pilot. Their views
and reflections on the intervention provided useful
information and insight into the impact that the therapists
had during their time in the school. The evaluation may
have been strengthened by the use of additional methods
to assess how changes identified by staff in the school
were implemented in practice. The data gathering occurred
at a time when the intervention was still fresh in the minds
of the teaching team. It would be interesting to conduct
follow-up interviews to establish whether initiatives that had
taken root in the schools have been sustained in the longer
term. It was not possible to gather the views of the children
who came into contact with the therapists; their views
would undoubtedly have strengthened the findings.
Acknowledgements
The author acknowledges the contribution to the evaluation and
assistance in the preparation of this article of Wendy Clarke, Lesley Perry
and Marian Nairac. Thanks to the two primary schools that participated
in the pilot and all the staff who gave generously of their time to
participate in the interviews. Thanks to Anita Volkert from Canterbury
Christ Church University. The evaluation was funded through a consultancy
arrangement between Eastern and Coastal Kent PCT and Canterbury
Christ Church University.
Key messages
Adopting a ‘whole school’ inclusive approach to delivering occupational
therapy in mainstream schools enabled occupational therapists:
■ To improve the engagement and participation of all children in a
range of school occupations.
■ To provide occupational therapy to children who for social reasons
may find it difficult to access occupational therapy services.
■ To gain greater insight into the demands on teachers and to take
account of the school environment when developing therapy
intervention.
■ To develop close trusting relationships with teachers and teaching
assistants that facilitate the active sharing of occupational therapy
knowledge and skills.
Eve Hutton
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