Using project-based learning for students to understand the occupational therapy process

Striving for occupational therapy students (OTSs) to comprehend the components of the therapeutic process of occupational therapy is a significant aim in higher education. The occupational therapy process is dynamic and has been operationally defined in the Occupational Therapy Practice Framework: Domain and Process (OTPF-4; American Occupational Therapy Association [AOTA], 2020): evaluation, intervention, and outcomes. Although the therapeutic process between a practitioner and client is dynamic and reflective (AOTA, 2020)., teaching the components of the therapeutic process can be accessible to students when explored in and out of the traditional classroom setting. Helping students develop understanding and competency in applying the therapeutic process will make them better practitioners to support their clients’ occupational participation. Teaching components of the therapeutic process also complies with the standards set by the Accreditation Council for Occupational Therapy Education (2023). Thus, identifying teaching methods to support OTSs knowledge and skills of the therapeutic process is valuable.

Effective teaching methods engage students in clinical reasoning and opportunities for application. Project-based learning is notably an effective method for teaching and is “defined as using authentic, real-world projects, based on a highly motivating and engaging question, task, or problem, to teach students academic content in the context of working cooperatively to solve the problem” (Bender, 2012, p. 16). The real-world issue offers a genuine learning experience that students may encounter in their clinical practice. The authentic experience defines project-based learning and increases student motivation as they address an existing problem rather than a supposed one (Bender, 2012). Project-based learning increases student motivation in learning and can contribute to student personal growth in life skills: time management, communication, critical thinking, self-direction, personal responsibility, problem-solving, creativity, collaboration, and work ethic (Wurdinger, 2016). When offered to OTSs, project-based learning can facilitate learning meaningful life skills they will use when interacting with future clients and colleagues, and in daily life. Bender’s components of project-based learning include 1)an anchor, 2) collaborative teamwork, 3) a driving question, 4) feedback and revision, 5) inquiry and innovation, 6) opportunities for reflection, 7) a process of investigation, 8) a publicly presented product, and 9) student voice/choice (2012). Project-based learning components are embedded within student experiences as they are features of this instructional method. What follows is a case-based explanation of how project-based learning was implemented by a professor to teach OTSs the occupational therapy process. This project was completed over the course of three semesters with eight OTSs. To introduce a topic, students are given a complex task to solve (i.e., a project anchor). The anchor given to the OTSs was occupational therapists addressing needs of siblings in families when one child has autism. As an introduction, students read articles about the needs of siblings who have a brother or sister with a disability and watched a video of those who were interviewed about their experiences of living with their sibling who had a disability. A collaborative discussion followed, where students posed questions and comments to one another and the professor in a group setting, to increase their understanding .

The next step in project-based learning is to develop a driving question. Bender notes that student choice is integral for active student participation (2012), and the driving question was developed through collaboration between the students and the professor to increase student motivation and engagement. The driving question was, “What does the occupational therapy process look like when working with a child with autism and their sibling without a disability?” Students collaborated to develop a series of tasks to problem-solve and address the question or a process of investigation, as outlined in Table 1. Reflection is part of the process throughout the learning steps.

Table 1. Project-Based Learning and Corresponding Actions

Each task was carried out in sequential order to support students’ understanding of the question and the occupational therapy process. The TPBA was selected as an evaluative measure due to its ecological and play-based assessment of developmental domains. The TPBA provides observation guidelines that were used by the OTSs to record play behaviors that the child with autism and their sibling exhibited, and students assessed the performance skills related to play. The SRS-2 was selected as a measure of the social skills of both the child with and without autism. This assessed the social ability of each child and allowed the OTSs to gather information about the social interaction skills of each sibling.

Two families, who each had one child with autism and had an interest in helping their children play together, were invited to the university where the OTSs implemented the occupational therapy therapeutic process with their children under the supervision of a licensed occupational therapist. An occupational profile of each family unit and each child was developed to understand their occupational strengths and needs. Each family unit consisted of a mother, father, and two children. The personal factors and interests of each child are described in Table 2.

Table 2. The Recipients of Occupational Therapy

Note. Pseudonyms used for all children

Each sibling pair was observed by six OTSs for an hour-long free-play session in a child-friendly sensory gym equipped with developmentally appropriate toys. During this observation, the OTSs completed the TPBA to gather information about each child’s play skills and interactions.

The TPBA assessment of Brian and Bailey revealed Brian’s strengths in memory and verbal communication; and areas of concern in motor planning, non-verbal communication, problem solving, and restricted play interests. His sister, Bailey, had strengths in fine motor skills, verbal communication, and problem-solving skills; and areas of concern in emotional self-expression, and making eye contact. In the second family, the OTS found Trey’s strengths to be his verbal communication, occasional eye contact, and memory; and concerns in impulsivity, self-control during activity transitions, and restricted play interests. Trey’s sister, Ella, had strengths in fine motor skills, verbal and non-verbal communication, emotional expression, and problem-solving; and a concern in her attention span.

A parent completed an SRS-2 for each child. This information was gathered to help the OTS understand each child’s social abilities related to social participation and social interaction skills. Scores above 59 reflect a significant concern in social ability. Both children with autism, Brian and Trey, scored in the significant range of social impairment on the SRS-2 for their total score and all subscales. Bailey scored in the significant range in motivation and restricted and repetitive behaviors, but her total score was in the range of typical development. Ella, Trey’s sister, had scores in the range of typical development.

After the evaluative information was gathered, the OTSs reflected on the findings and engaged in collaborative discussion to synthesize the information. Students identified and shared supports and barriers to occupational participation in sibling play and social participation. The impact of each child’s performance related to joint play, contexts, and environmental supports were discussed.

The OTSs noticed that the siblings Brian and Bailey preferred to play independently. Because of this, the OTSs reasoned together that the intervention plan should target social participation between them with parent support. The intervention plan focused on helping Brian and Bailey improve their understanding of play activities and expectations and to problem-solve during activities, creating opportunities for them to play together by embedding activities into daily routines, increasing communication, and regulating the social emotional skills needed to express their feelings.

In the second family, the OTSs reasoned together that the intervention plan for Trey, Ella, and their parents target social participation and emotional regulation. The intervention plan focused on helping Trey and Ella improve their time spent in sibling play, use teamwork to support interactions, plan for transitions between activities, and create opportunities for the siblings to play together by embedding activities in daily routines, increasing communication, and managing levels of arousal and stress.

Conclusion

Through a collaborative discussion of occupational therapy approaches, students appraised the OTPF-4 definitions of each approach and made decisions about which approach and strategies would match the children’s performance needs. The OTSs engaged in decision-making to write a home activity program that detailed each focus area and strategies to help the family.

The final step of project-based learning is to deliver a product that allows students to communicate their work to others. In this case, the OTSs delivered a product in three ways.

• One student met with each family to review the home activity program and implemented some of the strategies with the family.
• The OTSs prepared and presented a slideshow to their peers, faculty members, and family members during an on-campus scholarship day.
• The OTSs co-wrote a proposal for and presented a posted at the AOTA INSPIRE Annual Conference.

During the 3-semester-long project-based learning experience, the OTSs valued the discussion and collaboration: “I liked that we had discussed in class what we will be changing.” They practiced skills in communicating with each other and problem solving throughout the project. These life skills are a product of project-based learning (Wurdinger, 2016). Several students said that it was engaging to progress through the steps. Student A noted, “I thought it was exciting to see our project come to life,” and student B added, “I am excited to begin to see all of our work come together toward our final product.” Providing a real-life occupational therapy question to address gave the OTSs opportunities to practice clinical reasoning, communicate with recipients of occupational therapy services (children and families), develop creative strategies to facilitate social participation between siblings, and apply the steps of the occupational therapy process with a real family. Student C reflected on her observational skills during the experience: “I noticed a lot about the sibling relationship through observing their play!” Several students reflected on the environment’s influence on sibling play and discussed environmental modifications to support the children’s occupations. The students also saw how the real-life experience differed from their assumptions, and this experience elicited further clinical reasoning or wondering as student B called it. Student C commented on the play observation, saying, “It wasn’t what we expected, but I am glad to have had the opportunity.” The experience provided opportunities for problem-solving and creativity to adjust their thinking and actions—valued skills in working as a practitioner in the field. Project-based learning in occupational therapy is an effective teaching method that can help students learn about the occupational therapy process and practice meaningful life skills.

References

Accreditation Council for Occupational Therapy Education. (2023). 2023 Accreditation Council for Occupational Therapy Education (ACOTE®) Standards and Interpretive Guide. https://acoteonline.org/accreditation-explained/standards/

American Occupational Therapy Association (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

Bender, W. N. (2012). Project-based learning: Differentiating instruction for the 21st century. Corwin Press.

Constantino, J. N. (2012). Social Responsiveness Scale (2nd ed.). WPS.

Linder, T. W. (2008). Transdisciplinary Play-Based Assessment (2nd ed.). Brookes.

Wurdinger, S. D. (2016). The power of project-based learning: Helping students develop important life skills. Rowman & Littlefield.

Laura M. Zagacki, DHSc, OTR/L, is an Assistant Professor at the University of Scranton in Scranton, PA. She completed her master’s degree in occupational therapy in 2004 from Thomas Jefferson University and her doctoral degree in Health Sciences in 2021 at Drexel University. Laura’s clinical practice, spanning more than 20 years, has mainly been in pediatrics, with additional clinical experience in adult rehabilitation. She is committed to mentoring occupational therapy students in pediatric practice and family-centered care, and supporting siblings of children with disabilities.