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 …