VanderKaay, S., Dix, L., Rivard, L., Missiuna, C., Ng, S., Pollock, N., Whalen, S. S., Eisen, I., Kyte, C., Phoenix, M., Bennett, S., Specht, J., Kennedy, J., McCauley, D., & Campbell, W. (2021). Tiered Approaches to Rehabilitation Services in Education Settings: Towards Developing an Explanatory Programme Theory. International Journal of Disability, Development and Education, 1-22.
Rehabilitation disciplines (i.e., speech-language pathology, occupational therapy, physiotherapy) often use a range of approaches with increasing support as required (called tiered approaches) to provide interventions in education settings. In a Response to Intervention (RTI) or tiered approach, tier 1 services are provided at a classroom-wide level, tier 2 services are provided to students who require some additional support, and tier 3 services are provided to students who require individualized and more intensive services. There are several benefits to using a tiered approach to services including early identification of difficulties, reduction in waitlist times, etc. Some barriers include insufficient resources and lack of clarity regarding professional roles at different tiers. Although much is known about the outcomes of using a tiered approach to intervention services, there is a lack of specific explanatory theories related to tiered rehabilitation service delivery in education.
One way to develop a theory is to use Realist Evaluation. Using realist evaluation allows for the development of a theory that answers “how, why, for whom, to what extent and in what context”. Realist Evaluation allows for the identification and examination of variables that impact the outcome of a program. Realist Evaluation outlines that the outcomes of the program are impacted by both mechanisms (i.e., how individuals in the program respond to the program) and contexts (i.e., setting, structure, environments).
In this study, the authors identified that their main goal was to develop the first theory for tiered rehabilitation services in education settings. As a first step in achieving this goal, the authors completed a realist synthesis of the literature to identify the relevant contexts, mechanisms, and outcomes from articles collected in their literature review. The realist synthesis identified 52 articles that reported on tiered rehabilitation services in education. From these articles the authors summarized the findings relating to outcomes, context, and mechanisms. Within outcomes three factors were identified and themes were included within each category: children and youth (e.g., greater sense of inclusion), parents and professionals (e.g., increase knowledge and skill), and systems (e.g., timely intervention). Three different contexts were identified including the macro-level (e.g., high-quality, universal curriculum), meso-level (e.g., clear guidelines for tiered approaches), and micro-level (e.g., rehabilitation professionals with relevant skills). Three different categories were identified in mechanism including collaborative relationships (e.g., common frameworks), authentic services (e.g., services are fluid and flexible), and building capacity (e.g., give and take of ideas).
These results are a first step in building a theory for tiered rehabilitation services in education. Future work from these authors will look at the relationship between the contexts and mechanisms and the influence on the outcomes of a program. The results of this work will be useful for reflecting on the current use of tiered services and future application of this approach to service.
Blogger: Meghan Vollebregt is a student in the combined SLP MClSc/PhD program working under the supervision of Dr. Lisa Archibald.