Developing an initial explanatory theory for Partnering for Change using realist evaluation.
Sandra VanderKaay, Cheryl Missiuna, Sheila Bennett and 5 others
PMID 39354896WHAT IT FOUND
Researchers developed a theory explaining how school-based occupational therapy works, not just that it does.
Success depends on specific conditions: therapists must be open to collaboration, schools need supportive leadership, and therapists require paid training and mentorship to shift from individual caseloads to whole-school support.
Key findings
01The theory identifies four key areas for successful implementation: introducing the model to new contexts, establishing a foundation in schools, implementing the three-tier service model, and sustaining impacts over time.
02Critical contexts include organizational openness to innovation, designated liaisons in schools and health agencies, and principals who actively value the occupational therapist's presence.
03Mechanisms for success involve providing therapists with paid training and mentorship, which allows them to build a community of practice and confidently adopt a workload approach rather than a traditional caseload model.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
This is an initial explanatory theory, not a tested intervention model; the causal links are hypotheses based on past data, not confirmed by prospective trials. The analysis relied on retrospective recall from working group members about a study conducted years prior, which may affect accuracy. Several original investigators were not included in the working group, so their perspectives are missing. The study focused on one specific implementation of P4C in Ontario, Canada, which may limit applicability to other educational systems.
Declared interests
The authors reported no conflicts of interest. The research was supported by non-U.S. government funding.
The easy way to misread this
Do not treat this as evidence that P4C works. This paper describes the theory of how the model is supposed to work based on past data, not a new trial proving its effectiveness. The outcomes listed are expectations derived from documents and interviews, not measured results.