Occupational therapists’ perspectives about the challenges and opportunities of setting up a school-based occupational therapy service

Abstract

Background: School-based occupational therapy (SBOT) is a developing area of practice in Malta, driven by inclusive education policies aimed at supporting the participation of all learners. Despite this shift, no research has investigated the perspectives of occupational therapists (OTs) directly involved in delivering these services. Aim: This study aimed to explore the challenges and opportunities experienced by OTs during the implementation of a new SBOT service in mainstream Maltese primary schools. Method: A qualitative descriptive design was used to collect in-depth data from 5 school-based OTs and their mentor, all of whom were involved in the national SBOT pilot project. Semi-structured interviews were conducted to gain insights into participants’ professional roles, collaborative experiences, perceived barriers, and factors that supported their practice. Thematic analysis was used to identify key patterns and themes in the data. Findings: The results revealed several early challenges, including lack of role clarity, limited resources, time constraints, and difficulties in collaborating with educators and school leaders. However, participants also reported significant opportunities for growth. Over time, they developed stronger relationships with educational staff, became more confident in their roles, and were able to deliver more responsive, inclusive support to learners in natural school environments. The ability to intervene early and work directly within classroom settings was perceived as a key strength of the service. Discussion: This study supports the applicability of the collaborative whole-school approach within the Maltese context and highlights the importance of practical training, structured mentorship, and systemic measures that support a workload model. It offers important insights that can inform future policy, training, and service design for SBOT in Malta.