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Original Article • Cad. Bras. Ter. Ocup. 32 (spe1) • 2024 • https://doi.org/10.1590/2526-8910.ctoAO392537992 linkcopy

Open-access Occupational therapy in education in Latin America: an analysis from the Occupational Therapy in Education (TOE in Spanish) Community of Practice

AuthorshipSCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction  The Occupational Therapy in Education (TOE in Spanish) Community of Practice brings together occupational therapists from Latin America and the Caribbean related to the educational field. Framed in this community, it is understood that there is progress in the incursion of occupational therapy in education, but there is a lack of studies that analyze the reality of the region.

Objective  Analyze the state of occupational therapy in education in Latin America and the Caribbean from the perspective of members of the TOE Community of Practice to understand its scope, challenges and opportunities.

Methods  Members from Chile, Argentina, Bolivia, Colombia, Peru, Brazil, Venezuela, Mexico, Costa Rica and Panama presented the state of occupational therapy in education in their countries. This information was analyzed under a qualitative approach, adopting the content analysis method.

Results  In all participating countries, the presence of the occupational therapist in special education is a constant. In some, their actions in regular inclusive education are beginning to be visible, but the existence of legislation that supports this, varies. The need to incorporate new paradigms that guide the exercise of occupational therapy was evident since in most countries the rehabilitation approach persists.

Conclusions  The practice of occupational therapy in Latin America and the Caribbean is observed as eclectic; professionals use different approaches based on the needs of their educational systems and legislative opportunities. Theoretical frameworks adjusted to the realities of each country are required, followed by academic training in education and the generation of policies for occupational therapists’ incorporation into the inclusive regular system.

Keywords:
Occupational Therapy; School; Education; Latin America; Community of Practice

Resumen

Introducción  La Comunidad de Práctica Terapia Ocupacional en Educación (TOE) reúne terapeutas ocupacionales de Latinoamérica y del Caribe relacionados al sector educativo. Enmarcado en esta comunidad se comprende que existen avances en la incursión de la terapia ocupacional en educación, pero que faltan estudios que analicen la realidad regional.

Objetivo  Analizar el estado de la terapia ocupacional en educación en Latinoamérica y el Caribe desde la perspectiva de miembros de la Comunidad de Práctica TOE para comprender su alcance, desafíos y oportunidades.

Métodos  Miembros provenientes de Chile, Argentina, Bolivia, Colombia, Perú, Brasil, Venezuela, México, Costa Rica y Panamá expusieron el estado de la terapia ocupacional en educación en sus países; dicha información fue analizada bajo un enfoque cualitativo, adoptando el método de análisis de contenido.

Resultados  En todos los países participantes la presencia del terapeuta ocupacional en educación especial es una constante. En algunos empieza a ser visible su actuación en educación regular inclusiva, pero es variable la existencia de legislación que avale su vinculación. Se evidenció la necesidad de incorporar nuevos paradigmas que orienten el ejercicio de la terapia ocupacional ya que en la mayoría de países aún persiste el enfoque de rehabilitación.

Conclusiones  La práctica de la terapia ocupacional en Latinoamérica y el Caribe se observa como ecléctica, los profesionales usan varias aproximaciones basados en las necesidades de sus sistemas educativos y las oportunidades legislativas. Se requieren marcos teóricos ajustados a las realidades de cada país, acompañados por formación académica en educación y la generación de políticas para su incorporación en el sistema regular inclusivo.

Palabras clave:
Terapia Ocupacional; Escuela; Educación; Latinoamérica; Comunidad de Práctica

Resumo

Introdução  A Comunidade de Prática do Terapia Ocupacional na Educação (TOE) reúne terapeutas ocupacionais da América Latina e do Caribe relacionados ao setor educacional. Enquadrado nesta comunidade, entende-se que há avanços na incursão da terapia ocupacional na educação, mas que faltam estudos que analisem a realidade da região.

Objetivo  Analisar o estado do terapia ocupacional na educação na América Latina e no Caribe a partir da perspectiva da membros de Comunidade de Prática TOE para compreender seu alcance, desafios e oportunidades.

Métodos  Membros do Chile, Argentina, Bolívia, Colômbia, Peru, Brasil, Venezuela, México, Costa Rica e Panamá apresentaram o estado da terapia ocupacional na educação em seus países; Essas informações foram analisadas sob abordagem qualitativa, adotando-se o método de análise de conteúdo.

Resultados  Em todos os países participantes a presença do terapeuta ocupacional na educação especial é uma constante. Em alguns, o seu desempenho na educação regular inclusiva começa a ser visível, mas a existência de legislação que apoia a sua ligação é variável. A necessidade de incorporar novos paradigmas que orientem o exercício da terapia ocupacional ficou evidente, uma vez que na maioria dos países a abordagem de reabilitação ainda persiste.

Conclusões  A prática da terapia ocupacional na América Latina e no Caribe é observada como eclética; os profissionais utilizam diversas abordagens baseadas nas necessidades de seus sistemas educacionais e nas oportunidades legislativas. São necessários enquadramentos teóricos ajustados às realidades de cada país, acompanhados de formação académica em educação e da geração de políticas para a sua incorporação no sistema regular inclusivo.

Palavras-chave:
Terapia Ocupacional; Escola; Educação; América Latina; Comunidade de Prática

Introduction

Occupational therapy in education has become an emerging field in the practice of occupational therapists, which has been linked to the developments of each country or region. Occupational therapy in education is considered emerging because it is disconnected from traditional biomedical knowledge and relies on other knowledge such as social humanistic to begin to consolidate other ways in which occupational therapy is thought and done (Bazyk & Cahill, 2015; Bonnard & Anaby, 2016; Parra-Esquivel, 2022). The evolution of this field has allowed it to be established as another space of practice, without losing the essence of the profession and at the same time, generating greater developments and professional opportunities (Álvarez, 2010).

This has required an analysis of the possibilities in the daily actions of educational contexts, the different ways of entering educational systems, the possibility of articulation with other fields, and the need to demonstrate the contribution of the profession. As an emerging field in permanent development, it brings with it particular challenges and opportunities in terms of inclusion and attention to diversity. In Latin America and the Caribbean, many countries have recognized the importance of promoting inclusive education that guarantees the participation and learning of all students, regardless of their abilities and needs, a relevant aspect to consider in the professional practice of occupational therapy in education (Marchesi, 2019; Organización de las Naciones Unidas para la Cultura, 2020).

According to the World Federation of Occupational Therapists (WFOT), occupational therapy plays a relevant role in the challenge of inclusive education, by providing support and services that contribute to the comprehensive development of students and their performance and participation in educational environments (Federación Mundial de Terapeutas Ocupacionales, 2016). These supports mainly address the barriers that limit students' participation and learning, supporting components such as attention, fine and gross motor skills, self-regulation skills, socialization and autonomy. Occupational therapists work in collaboration with educational teams and students to identify and address these difficulties, promoting the development of skills necessary for occupational performance and participation in the school environment (Edick et al., 2022).

In Latin America and the Caribbean, occupational therapy faces common challenges in fulfilling its professional role in education, such as lack of resources, shortage of trained professionals, and the need to strengthen interdisciplinary collaboration (Blanco & Duk, 2019; Marchesi & Hernández, 2019). To respond to these challenges and share experiences, the Occupational Therapy in Education (TOE) Community of Practice was created, which brings together an independent group of around 40 occupational therapists (in professional practice, in university teaching, and in research) from Latin America and the Caribbean interested in the contribution and development of occupational therapy in education in our region (Farias et al., 2022). The mission of this community is to promote the exchange of knowledge, experiences, and research related to occupational therapy in the educational field in the region (Figure 1). Its vision is to become a reference in Latin America and the Caribbean, contributing to the development of occupational therapy in education and generating a positive impact on the inclusion and development of students. To this end, monthly online meetings and activities are organized that promote dialogue and collaboration among its members on previously raised topics, seeking to strengthen professional ties, share resources and generate projects that contribute to the development of occupational therapy in education in the region (Farias et al., 2022).

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Figure 1
TOE Logo. In it is says Latin American group in education.

This study is framed in the context of the meetings and activities carried out in TOE, since it is through the exchange of knowledge of different members of the community that shared needs are detected. Within these needs, two stand out, which support this research. The first refers to the scarcity of studies on occupational therapy in education in Latin America and the Caribbean. Although significant progress has been made in the implementation of occupational therapy in education in the region, there is a lack of comprehensive studies that analyze its status. This study aims to contribute to filling this gap and provide a clearer view of the achievements and challenges in this field. A second reason considers the need for collaboration and peer learning. The TOE Community brings together professionals from different countries, allowing the exchange of knowledge, experiences and practices. This study aims to foster collaboration and peer learning, strengthening the community and promoting excellence in the practice of occupational therapy in education.

The objective of this study is to analyze the state of occupational therapy in education in Latin America and the Caribbean from the perspective of the TOE Community of Practice, in order to understand its scope, challenges and opportunities in the educational context of the region.

Method

A qualitative documentary approach was used to examine and understand the state of occupational therapy in education in Latin America and the Caribbean from the perspective of the TOE Community of Practice. To do so, the content of various PowerPoint presentations made in the first half of 2021 by representatives of the following countries was analyzed: Chile, Argentina, Bolivia, Colombia, Peru, Brazil, Venezuela, Mexico, Costa Rica and Panama. These presentations are part of the files in the custody of the TOE community of practice, to which all members had access at the time of this research. Each presentation lasted approximately 20 minutes and considered seven aspects that were presented as a first approximation based on the knowledge and experience of each of the contributors. These aspects included:

  1. History: It addressed the origin and evolution of occupational therapy in the educational field, highlighting the relevant milestones and events that have marked its development over time.

  2. Legislation: Examined the legal framework related to occupational therapy in education, including laws, policies, and regulations that support student inclusion and rights.

  3. Professional growth: Focused on the development and expansion of the occupational therapy profession in the field of education.

  4. Educational system: Addressed the characteristics and structures of the educational system, identifying educational practices and their impact on the practice of occupational therapy in education.

  5. Modality of care: Focused on the modalities covered by occupational therapists in educational contexts.

  6. Roles of occupational therapists: Examined occupational therapy practice and services delivered in educational contexts.

  7. Challenges faced: Focused on identifying challenges that affect the development and participation of occupational therapists in educational contexts.

In the development of this research, the ethical guidelines described in Resolution Number 8430 of Colombia were followed, which establishes the scientific, technical and administrative standards for health research (Colombia, 1993) and Law 20.120 of Chile1 on scientific research in human beings (Chile, 2006). Therefore, this research was carried out considering principles such as voluntary participation, non-maleficence and informed consent. In addition, the WFOT code of ethics regarding professional conduct when participating in research was considered (Federación Mundial de Terapeutas Ocupacionales, 2020).

Considering the ethical guidelines described above, this study took care not to compromise the physical, emotional integrity or health of those members of the TOE Community who contributed with the information analyzed (hereinafter contributors). The contributors were occupational therapy professionals who were either practicing or engaged in university teaching and/or research, representing the 10 countries identified (Table 1).

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Table 1
Characteristics of the Contributors.

Each contributor was informed about this research, its objective, its voluntariness, and the benefits and requirements of their participation. Their authorization was requested through an informed consent form, which they all signed. In addition, the results were sent to each contributor for review, and they had the opportunity to request any modifications they deemed pertinent, in addition to corroborating their veracity.

Analysis

The content analysis was carried out through a systematic process of coding and categorizing the data obtained from the presentations made by the contributors. To do so, the seven aspects mentioned above were considered as units of analysis, which were analyzed using a constant comparative method (Corbin & Strauss, 2015; Flick, 2018). This analysis was carried out in several stages. In the first instance, the information provided in PowerPoint format was transferred to a Word table, which was shared with the contributors to corroborate and complement it. Then the coding process began, using the color marking technique, looking for similarities in each of the aspects analyzed. Later, common themes were identified through constant comparison, considering those that were repeated in two or more countries, which were assigned a name according to the language used in the presentations.

Results

The results are delivered following the logic of the aspects addressed in the presentations analyzed. Table 2 presents a summary of the common themes identified in each of the aspects addressed. It should be noted that in each of these aspects the contributors were free to present what they believed appropriate, which represents the information that at the time of the study contained their own data and experiences. Each of the common themes is described, presenting at least two examples from the countries that were represented in this study and identified in Table 2. These examples were selected for containing clear, complete and representative information, also considering that they met the criteria for article length.

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Table 2
Summary of results.

History

  1. Occupational therapy began in the field of special education: This connection between occupational therapy and special education was fundamental for the development and inclusion of the discipline in the educational system. Representatives from Argentina, Brazil2 and Chile reported experiences of occupational therapists in special education from 1970 to date. Mention was also made of the participation of occupational therapy in special education institutions and school integration for children with Special Education Needs (SEN) in public regular education institutions in Colombia in 1991-1994. Representatives from Costa Rica report that professional training was based on SEN and disability. Regarding Peru, it was indicated that in 1970 the occupational therapy course began at the School of Medical Technology of the Faculty of Medicine of the National University of San Marcos, the first fields of action were linked to special basic education. In Venezuela, for their part, contributors pointed out that occupational therapy has been present in the field of education in special educational institutions for more than 40 years

  2. Training professionals abroad: This point is considered essential for the creation and promotion of the profession in public and private universities. Members from Chile shared that in 1963 the University of Chile created the occupational therapy degree and offered six scholarships so that some of the first professionals could do their training in Buenos Aires. Then in 1972 it approved its own study plan and in 1995 it created the degree, to be transformed in 1996 into the occupational therapy profession. The exhibitors from Panama indicated that in the early days of the profession, occupational therapists were trained at universities in Brazil and Mexico, and in 2000, the Specialized University of the Americas opened an occupational therapy program with its first class of graduates in 2004. In Venezuela, in 1959, the United Nations (UN) sent Canadian occupational therapist May Hamilton to begin training programs at the Venezuelan Social Security Institute.

Legislation

  1. Policies for the incorporation of occupational therapy in the educational system: refers to the government measures and actions implemented in different Latin American countries to promote the inclusion of occupational therapy in the educational field. According to what was described by contributors from various countries, laws and educational policies have historically been enacted that support this inclusion, recognizing the importance of occupational therapy in the development of students with special educational needs. Members of countries such as Colombia pointed out that in the first decade of the 2000s they managed to legalize the practice of occupational therapy in the educational field. From Costa Rica, it is indicated that the practice is supported by Law Number 12 with the creation of the National Insurance Institute, and from Panama it is indicated that since 1969 the occupational therapy service began in a government institution. Regarding these and other policies, in general they seek to ensure the participation and equitable access of students who require occupational therapy intervention within the educational system, varying their scope and focus according to the needs and priorities of each country. For example, representatives from Costa Rica shared that inclusive education has been promoted as a framework for occupational therapy intervention in the educational field. In Chile, occupational therapists have been legislatively recognized as educational assistant professionals who have been part of school integration programs since 2019. In addition, members from Colombia stated that occupational therapists can be appointed as mentor teachers to promote the active and effective participation of students with disabilities or exceptional talents according to legislation dating back to 2019.

  2. Absence of specific regulation: Although various spokespersons from countries such as Costa Rica, Chile and Colombia show in their presentations that there is current regulation for the practice of occupational therapy in educational contexts, this is not shared by other countries in the region. Members from countries such as Bolivia, Mexico and Peru pointed out a lack of specific regulations governing occupational therapy in the educational field. In Venezuela, occupational therapists appear within special education regulations, but not in regular education legal regulations. The absence of specific regulations may present challenges for the development and implementation of therapeutic services in the educational context of these countries.

Professional growth

  1. Training: Representatives from Mexico pointed out that the opening of institutions that promote a degree in occupational therapy, for example the Universidad Autónoma del Valle de México. While this has contributed to a greater availability of training programs and a greater diversification of the areas of specialization within the discipline, they are still insufficient to meet the needs of the population. In other countries such as Peru, an evolution in the training and approach to occupational therapy in the educational field was pointed out. Initially, it focused on rehabilitation and disability, later it was oriented towards the optimization of learning in state and private schools and currently an inclusive approach is promoted to incorporate the participation of the family and the community. Occupational therapists work in collaboration with other professionals and parents to provide a comprehensive and centered approach in the school context. Representatives from Venezuela pointed out that in regular schools it has served as an internship center for occupational therapists, who train students and interns of the career, thus strengthening the relationship between occupational therapy and education.

  2. Research and academia: Members of some countries pointed out that the number of scientific publications associated with occupational therapy and education has increased, as well as the number of events developed to benefit the creation and knowledge of occupational therapy. Representatives from Brazil showed the increase in the production of knowledge on occupational therapy and education, mainly in recent years, where an increase in publications that address this topic on a more regular basis has been observed. This phenomenon indicates a consolidation of the professional field and a greater interest on the part of researchers in exploring the relationship between occupational therapy and education. Regarding academic events, representatives from Argentina highlighted the permanent holding of congresses, conferences and academic meetings that bring together professionals and experts in the field to share knowledge and experiences. As an example, they mentioned the eleven national congresses that have been held since 1985, among which the one from 2015 stands out due to its large number of works related to education. They also pointed out the seven meetings were held since 2017 by the Occupational Therapy Chapter in Schools and Other Educational Contexts from the Argentine Association of Occupational Therapy.

  3. Participation in work teams: Contributors from countries such as Chile and Mexico shared that there has been an increase in the participation of occupational therapists in pedagogical groups, implementing various practices that allow the empowerment of the educational community and their role within the school process of students. Representatives from Argentina demonstrated the participation of occupational therapists in management positions that give importance to teamwork.

  4. Development of own models: In Colombia, various models have been developed that have influenced the practice of occupational therapy in the educational field, one of these is the Model of Occupational Performance of the School Child (DOE in Spanish), which incorporates a holistic view of Performance (Álvarez, 2010). Currently, a proposal is being developed considering the framework for occupation-based practice (Bass et al., 2017) and the perspectives of occupation-centered practice with children (Rodger & Kennedy-Behr, 2017). In Venezuela, the Functional Integration Therapeutic Model developed by Concetta Giorgini and Santana has been proposed. Although this model is in the process of consolidation through revisions and adjustments, it has been applied in practice and implemented in regular schools both in normal situations and during the pandemic.

Educational system

  1. Management of the educational system: different entities were identified that play a fundamental role in the formulation of educational policies, the implementation of programs and the supervision of education that affects the practice of occupational therapy in educational environments. Their responsibility covers aspects such as curricular planning, resource allocation, evaluation of school performance and the promotion of inclusive education. These entities include: the General Directorate of Culture and Education in Argentina, the Ministry of Education and Culture in Bolivia, the Ministry of Education in Chile, the Ministry of National Education in Colombia, the Secretariats of Education, the Ministry of Public Education in Costa Rica, the Secretariat of Public Education in Mexico, the Ministry of Education in Panama, the Ministry for the Popular Power of Education in Venezuela, and the Ministry of Education and Culture in Peru.

  2. Characteristics of the school system: some characteristics of each educational system that could affect occupational therapy practice were identified. However, all contributors pointed out that the school system is organized into three levels (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Mexico, Panama, Peru and Venezuela). These levels include preschool or initial level, primary or basic education and secondary or middle education. There are differences in terms of the compulsory nature of these levels. For example, spokespersons from Argentina pointed out that education is compulsory and free at all levels, while representatives from Bolivia indicated that primary education is compulsory and free, and secondary education is optional.

  3. Financing of education: In most of these countries, the educational system receives financial support from both the federal government and local entities. For example, speakers from Argentina showed that the General Directorate of Culture and Education is responsible for financing and managing resources for the educational system. In Bolivia, the Ministry of Education and Culture is also responsible for providing funds for education in the country. According to contributors from Chile, there is a financing system through the Ministry of Education, where educational institutions can be public, private or with mixed financing. In addition, financial resources are allocated to the education system through the national budget and territorial entities.

  4. Inclusive education: Some countries have implemented policies and measures to ensure that all students have access to quality education, regardless of their characteristics or needs. For example, speakers from Costa Rica highlighted that the Ministry of Public Education has promoted inclusive education as part of its educational approach, providing opportunities for the participation of all students in the system. Members from Mexico also stated that the Secretariat of Public Education also works to promote inclusive education. In Colombia, various measures have been implemented through Decree 1421 of 2017, which establishes the guidelines to guarantee access and participation of all students, including those with disabilities or special educational needs (Colombia, 2017). In Venezuela, inclusive education has been established in Article 14 of the Organic Law of Education (Venezuela, 2009).

  5. Special education and education for people with disabilities: Several contributors stated that policies and programs have been established in various countries to address the educational needs of this specific group of students. In Panama, for example, the speakers presented the creation of the Panamanian Institute for Special Habilitation, an autonomous entity dedicated to the education of people with disabilities. In Venezuela, they highlighted that the Ministry of Education, Culture and Sports has a basic education subsystem that includes special education levels to serve students with diverse conditions and difficulties. In Chile, they stated that the Ministry of Education provides services to this group through school integration programs aimed at students with special educational needs.

Modalities of care

  1. Regular education: All contributors highlighted the development of training workshops for all participants in the educational community. In addition to providing care to students with special educational needs, they also highlighted the advice on school curricula, guidance and counseling for successful inclusive education and universal quality of education. In Brazil, it was also expressed that occupational therapists participate in the management of social and assistance technologies, resources and devices in regular schools through a collaborative consulting model and also from a social approach, based on social occupational therapy, generating practices towards the internalization of citizenship, rights and social practice. Presenters from Chile shared that occupational therapists participate through individual and group actions for advice and preparation towards productive, functional and work life, the latter associated with high school students. Members from Venezuela pointed out that occupational therapists participate through the design of healthy lifestyle programs.

  2. Special education: The participation of occupational therapists in special education is present in different modalities of action, including environmental modifications in schools, workshops on Activities of Daily Living (ADL) and individual evaluations. Representatives from Argentina mentioned that there are schools and comprehensive training centers that provide care to students with disabilities aimed at job readiness and training through workshops and internships. In Brazil, advice is provided to the educational community on the use of assistive technology, alternative and expanded communication, and alternative mobility.

  3. Non-formal education: It was explained that in Bolivia there are educational modalities such as special education centers outside the public system, which offer specialized interventions, including occupational therapy. In Colombia, they also showed various modalities, such as homeschooling, micro schooling and educational activities for artistic and occupational development. In Costa Rica, it was stated that occupational therapists provide direct care in offices, therapy rooms, in addition to providing itinerant support in public schools and participating in resource centers for inclusion. On the other hand, in Peru, occupational therapists are part of the early intervention program, the support and advice services for special needs and the programs in technical-productive education centers, which promote articulation with educational institutions, facilitating the transition and progression in the educational and productive path of students.

Roles of occupational therapists in education

1) Design of school curricula: Contributors from various countries shared the idea that occupational therapists contribute to the design of inclusive school curricula, providing advice on curricular programming, classroom strategy plans, and design of special programs. For example, speakers from Argentina pointed out that advice is provided on curricular programming at the initial level and in special schools, while in Brazil they focus on resources and devices for the practice of occupational therapy at school. In Bolivia, the goal is to provide inclusive educational environments through education for teachers and parents about routines, independence, and motor skills, and in Chile, they are part of the team of school integration programs.

2) Areas of intervention: Different areas of intervention of occupational therapy in the educational context stand out, including: sensory-motor development for learning and occupational performance, ADL workshops, vocational support and guidance. Contributors from Colombia shared the use of the DOE Model, and that they provide school guidance in preschool, primary and secondary education. From Mexico, they indicated that sensory-motor stimulation is provided in the initial stage (1 to 3 years) and support in sensory skills within the classroom in the preschool stage (3 to 6 years).

3) Advising classroom teachers: refers to support and advice to regular classroom teachers, providing strategies and curricular adaptations to serve students with diverse educational needs. For example, speakers from Panama mentioned that occupational therapists provide advice and participate in interdisciplinary teams at all educational levels. In Argentina, it was noted that they work closely with teachers to implement curricular adaptations and inclusive strategies, teachers are trained in adapting materials and in creating accessible environments to promote the participation of all students. In Mexico, it was indicated that occupational therapists work together with teachers to develop sensory-motor strategies that improve the occupational performance of students in the classroom.

4) Follow-up: These are responsibilities associated with the proper cessation of services and the follow-up of students. From Bolivia, it was shared that occupational therapists carry out thorough initial assessments to determine the needs of students, then periodic follow-up is carried out to measure progress and adjust interventions as necessary. In Chile, a follow-up process is implemented that includes regular assessments and team meetings to monitor the development and occupational well-being of students.

5) Participation in interdisciplinary teams: It takes into account the importance of collaboration between professionals from different disciplines to address the needs of students and develop comprehensive intervention plans. Representatives from countries such as Chile mentioned the participation of occupational therapists in technical meetings to discuss cases and coordinate joint actions. At the pedagogical level, from Peru it was pointed out that occupational therapists contribute to curricular planning and the design of inclusive strategies to promote the participation of all students. In Panama, at the management level, they provide advice and guidance in decision-making related to the inclusion and occupational well-being of students.

6) Types of intervention: Addresses the variety of interventions that occupational therapists provide, including prevention, individual and group interventions through practices aimed at the educational community in general. In Colombia, it was noted that occupational therapists play an important role in prevention and primary care in the educational field; they work in collaboration with the educational community to promote healthy practices and offer training on occupational well-being. In Venezuela, individual and group interventions are carried out to develop specific occupational skills and encourage social interaction and collaborative learning

7) Characteristics of the students: establishes aspects such as the social and school inclusion of children with disabilities, attention to students with special educational needs, and the existence of specialized classrooms to serve these students. For example, contributors from Argentina highlighted that social and school inclusion for children with disabilities is promoted through the implementation of individualized support programs and the creation of inclusive environments. In Chile, attention is provided to students with special educational needs who present difficulties associated with Autism Spectrum Disorder (ASD) or motor disabilities, supporting them through the adaptation of activities and the provision of adequate resources. In Mexico, students with special educational needs are served, including those who experience temporary emotional or learning difficulties, through therapeutic interventions and emotional support. In addition, support is provided to students without a specific diagnosis who present difficulties in their occupational performance. Contributors from Peru indicated that specialized classrooms are established for the care of children with diverse educational needs, which have resources and trained professionals, such as occupational therapists, to provide individualized support and adapt the curriculum to the needs of each student.

Challenges

  1. Lack of policies for the participation of occupational therapists in education: Countries such as Bolivia and Costa Rica indicated a lack of legislation and regulations that support the presence and participation of occupational therapists in the educational system. Representatives from Argentina, while indicating the existence of regulations that consider occupational therapists as part of the teams of special schools in some provinces, emphasized the lack of legislation for recognition as suitable professionals to work in common schools or regular education.

  2. Outdated academic curricula in the training of occupational therapists: Contributors from Brazil and Chile expressed the need to update the academic curricula of occupational therapy courses since current training is based on clinical and functional approaches, which does not fully meet the needs and demands of the educational field. In Colombia, it was proposed to strengthen the use of Information and Communication Technology as a mediator in the training of occupational therapists, as well as evidence-based practice.

  3. Lack of training and research: The lack of training opportunities and the content of those that exist regarding occupational therapists working in the educational field is a challenge shared by members of countries such as Bolivia, Chile and Mexico. Likewise, representatives of countries such as Peru and Chile expressed the lack of research in the field of occupational therapy in education and referred to it as one of their main challenges.

  4. Low visibility of occupational therapists in education: From different countries such as Chile, Mexico and Venezuela, the lack of recognition and visibility of the role of occupational therapists in the educational community was highlighted. That is, there is a lack of knowledge on the part of teachers, families and other professionals about their skills and contributions at the different levels of education.

Discussion

The results described reveal a series of themes that offer a global vision of the progress of occupational therapy in education in Latin America and the Caribbean. One of them is that occupational therapy in education had its beginnings in special educational institutions, such as special schools, being the first step for its incursion into the educational system. This is reflected in Table 2, since the majority of contributors highlighted a relationship between occupational therapy and special education institutions, a link that until the time of this study remains strong in countries such as Chile and Argentina. Álvarez (1994) and Rodríguez Mendoza et al. (2016) report that in Colombia, intervention in special education became widespread since the late 1970s, having its origins in the Special Education Center of the Hospital de la Misericordia. In their historical overview of the professional practice of occupational therapy in the educational sector, Monzeli et al. (2019) analyzed the historical processes in the creation of occupational therapy in countries such as Colombia, Brazil, Mexico, Argentina, Venezuela and Chile, highlighting this connection, alluding to the impact of institutions such as the World Health Organization (WHO) and the United Nations Educational, Scientific and Cultural Organization (UNESCO). What was identified by Monzeli et al. (2019) also finds similarity with the presence of international cooperation movements, which is linked to the training of professionals abroad. These findings reflect the appropriation of foreign knowledge in the origins of occupational therapy in different countries in Latin America and the Caribbean.

The connection between occupational therapy and Special Education would also explain the use by contributors of the term SEN, a designation that has fallen into disuse mainly due to the birth of terminology associated with inclusion. It is worth noting that from the World Declaration on Education for All, where rights are proposed with a perspective of equity and inclusion, to the Incheon Declaration, with a view to inclusive and equitable education, the notions of inclusion are raised using concepts similar to those identified here (Organización de las Naciones Unidas para la Cultura, 1990, 2015). In this research, it is observed that, in the reality of professional practice, the terminology of SEN remains current, regardless of the alignment with inclusive trends by occupational therapy professionals. Furthermore, because this terminology is validated with the perspective of special education and educational inclusion given by the United Nations Organization for Culture (Organización de las Naciones Unidas para la Cultura, 2024), where the Salamanca Declaration, the Framework for Action on Special Education Needs and the Education 2030 Agenda are taken up again, specifically in the Sustainable Development Goal (SDG4) (Organización de las Naciones Unidas para la Cultura, 1994, 2020, 2024). Research on the discourse used in educational contexts in Chile, for example, supports what is stated here, indicating that terms originating from a more medical model are used by the educational community in these contexts, including occupational therapists (Apablaza Santis et al., 2021; Iturra, 2019; Muñoz et al., 2015). Despite this, this connection has been changing due to the transformation of the approach to educational needs, declarations on equality in the right to education and diversity policies, opening the way to inclusive education.

However, this study shows that the rehabilitation paradigm is still a priority in the practice of occupational therapy in education, since the work is directed towards trying to adjust the characteristics of students to their school reality using terminologies associated with the field of occupational therapy in health. For example, terms such as intervention, diagnosis, discharge, referral and treatment remain in force. Despite this evidence, emerging experiences were identified in the approach to inclusive education, expressed by contributors from Brazil and Colombia. These experiences emphasize the role of the family and all those involved in education, interdisciplinary work, collaboration, and reflection on the opportunities for action with the educational community under a rights approach, considering access, permanence, and participation and learning of the entire community as relevant. This finding is corroborated by what was reported in Brazil by Fonseca et al. (2018) and in Austria by Morgenthaler et al. (2023), who identified occupational therapists who assist regular schools to address issues of school inclusion, indicating the importance of occupational therapy in regular education and the need to reflect on democratic educational systems.

Hand in hand with this transformation process has been the legalization of the practice of occupational therapy, which in some countries has been at the level of special education (i.e., Argentina) and in others at the level of regular education (i.e., Chile). For example, in Colombia, Law 115 of 1994 provided guarantees to ratify the right to education and the generation of public policies for the education of people with limitations and exceptional abilities in regular schools (Colombia, 1994). In addition, through Decree 366 of 2009, the profile of occupational therapist was incorporated as pedagogical support personnel and complementary to education (Colombia, 2009). In addition, Resolution 253 of 2019 allows occupational therapists to join public schools in the position of Guidance Teacher and as part of the school staff, making this a differential aspect with respect to other Latin American countries (Colombia, 2019). However, in most countries there were no laws that recognize the involvement of occupational therapists as personnel of the regular education system with an inclusive approach. That is why this study shows the need to substantiate policies for the incorporation of occupational therapists in the regular education system with an inclusive approach in Latin America and the Caribbean. This need has been demonstrated in other studies in the region. For example, Dinamarca-Aravena (2023b) showed in her study of health professionals in school integration programs in Chile, the need for public policies to be consistent with the objectives of inclusive educational approaches. Knowing the different legislative realities, therefore, emphasizes the importance of having policies that allow occupational therapists to fulfill the mandate of contributing to an inclusive education that allows all students to participate in the occupations of their choice (Federación Mundial de Terapeutas Ocupacionales, 2016). To do so, it is necessary that groups of occupational therapists in educational sectors generate work mechanisms with associations and colleges to address the need for a framework for the practice of the profession in inclusive education.

The analysis of the origin and evolution of the profession also allowed to raise awareness about how the profession has gone through significant legal, training and construction milestones of its own knowledge and expertise in this field. In this sense, the creation of models such as the DOE Model in Colombia (Álvarez, 2010) and the Therapeutic Model of Functional Integration in Venezuela, are attempts to ground the practice according to the history and characteristics of their own educational systems. This is a trend also evident in countries such as Canada, with the Partnering For Change (P4C) model (Camden et al., 2021; Campbell et al., 2012; Missiuna et al., 2017) and in Brazil with the conceptualization of the notion of radical inclusion in education as a guide for the professional actions of occupational therapists (Esquerdo Lopes & Oliveira Borba, 2022). These models demonstrate a methodology that adapts to the context in which they are developed. However, this study allows us to identify that the practice of occupational therapy in Latin America and the Caribbean is eclectic, using different types of approaches according to the pace of growth of the profession in each country, the needs expressed by their educational systems, by the legislative opportunities of governments, and the perspective of the occupational therapists who develop it.

This study also shows that occupational therapy practice is already demanded by interdisciplinary teams and communities to support the needs of students in their schooling occupations, under the threshold of knowledge of our profession. According to UNESCO, interdisciplinary work in educational contexts is a priority among government efforts in Latin America (Organización de las Naciones Unidas para la Cultura, 2020). This is because studies show that although progress has been made with respect to inclusive education, mainly in terms of access, this is not shared by all countries in the region (Blanco & Duk, 2019). Nor has it been accompanied by strategies that allow students to remain, continue and benefit from their educational experiences, among which the development of interdisciplinary approaches stands out.

The above is evidenced in this study as essential within the actions of occupational therapists, which corroborates what has been identified in other regions of the world regarding the relevance of interdisciplinary work in the practice of occupational therapy in education (Benson et al., 2016; Edick et al., 2022; Suc et al., 2017). Furthermore, the relevance of interdisciplinary work is evidenced in a study carried out in Saudi Arabia, which highlights the link between occupational therapists and special educators, psychologists and speech and language disorder specialists (Alatifi et al., 2023). Other studies focused on motor coordination problems corroborate what was pointed out by the contributors, by identifying work actions with classroom teachers and interdisciplinary teams. Thus, in Spain, Delgado-Lobete et al. (2019) highlights the importance of the work of occupational therapists in support teams to address educational challenges due to Developmental Coordination Disorder (DCD). In Australia, Mathwin et al. (2024) refer to collaboration with classroom teachers and other specialists to address handwriting processes from occupational therapy in education. These studies demonstrate the relevance of interdisciplinary work throughout the world and in a variety of areas of action, which is identified in this study for Latin America and the Caribbean.

In addition to the interdisciplinary work within the actions identified in this study, it was found that occupational therapists adapt different strategies to the individual and group needs of students, and provide direct and indirect support through individualized interventions, group activities, and environmental adaptations. This finding has similarities with studies that allude to the action modalities of occupational therapists in a variety of countries. For example, a study conducted in Brazil suggests that occupational therapists contribute to the inclusion of children with various conditions, including those with Autism Spectrum Disorder (ASD), Cerebral Palsy (CP), and Attention Deficit Hyperactivity Disorder (ADHD) through strategies such as those identified in this study (Lins et al., 2023). In addition, Lins et al. (2023) connected school occupations with the national curricular framework for early childhood education in Brazil, which favors the linking of occupational therapy with regular education. These points are related to the findings of this study, where regulations allow the professional practice of occupational therapy, and in this case, they also link participation in school contexts with children's occupations. Another study that investigated the participation of occupational therapists in two models of support for students with ASD in Australia identified that they contribute either through a specialized intervention or as part of a multidisciplinary support team (Carter et al., 2019). These actions are related to the results of this study, finding strategies associated with adaptations to the curriculum, training of parents and school staff, advice to teachers and support in the development of individualized educational plans. Another research carried out in the United States shows the relationship between age and the strategies used with students with ASD, identifying a strong relationship between interventions such as occupational therapy in the initial years of education (Mire et al., 2015). The same is evident in a systematic study regarding the publications of interventions carried out by occupational therapists in school contexts, which highlights strategies similar to those described here and work focused on students in their initial years of education (Salazar Rivera et al., 2023). These findings consolidate the results of this study because they make a link between the actions of the profession, interdisciplinary work, and a biomedical and ecological view of the practice of the profession.

In relation to the challenges, they highlight the importance of academic curricula and the linking of emerging practices to them, reinforcing the concern of the training of occupational therapists with the contemporary challenges of the world. They also highlight the importance of the development of research in different countries in the region, an aspect also highlighted by Oliveira Borba et al. (2020), who found a diversity of studies in a bibliographic review, but from Latin America and the Caribbean they only found studies from Brazil. Taking charge of both aspects would lead to better visibility of the profession in educational contexts. These findings make sense with other studies such as that of O’Donoghue et al. (2021) in Ireland, in which the focus has been on the training of occupational therapists, so that continuous learning is encouraged and they are strengthened as a learning organization. In Latin America, a study in Chile on the training of health professionals working in educational contexts, including occupational therapists, revealed that this training was insufficient for the work that must be performed in these contexts (Dinamarca-Aravena, 2023a). Thus, various authors have identified the need to pay greater attention to the professional training of occupational therapists working in educational contexts, an aspect shared by the contributors to this study.

Other studies have identified aspects that support the insertion of this emerging area in academic curricula. In Brazil, for example, it was identified that the current regulations for the degree in occupational therapy emphasize the recognition of human needs in various fields including the area of ​​education (Roriz et al., 2023). At the same time, the specialty of occupational therapy is recognized in the school context, identifying which occupational therapists are competent to work in regular or special education, in all its modalities and levels to promote inclusion (Roriz et al., 2023). This shows progress in standards and updates in the field of occupational therapy training in countries such as Brazil. According to the findings of this study, these updates seem to be relevant in various countries in the region, which is linked to the lack of regulations for the action of occupational therapists in educational contexts.

Conclusions and Recommendations

The analysis of occupational therapy in educational contexts in Latin America and the Caribbean from the perspective of the TOE Community reveals important advances and challenges in the implementation of this discipline in the educational field.

Firstly, the progress in the generation of regulations and legislation that supports the participation of occupational therapists in the educational system is highlighted. This legal recognition has allowed the inclusion of occupational therapy in different roles within educational institutions, providing support to students mainly with special educational needs and contributing to their comprehensive development. Secondly, in some countries a change of focus is observed in occupational therapy in the educational field, which has led to a greater emphasis on the active participation of the family and the community, as well as collaboration with other professionals, such as psychologists, pedagogues and social workers. Thirdly, interdisciplinary work has gained relevance in occupational therapy in education, recognizing the importance of collaboration with other professionals and the implementation of interdisciplinary approaches. This collaboration has allowed for the implementation of group interventions and promotion and prevention aimed at the educational community as a whole, thus strengthening the quality of care provided to students.

Despite the above, there are significant challenges that still need to be addressed in the implementation of occupational therapy in the educational field in Latin America and the Caribbean.

One of these challenges is the duty to ensure adequate regulations regarding the incorporation of occupational therapy in educational contexts in all countries of the region, and to update the existing ones to relate occupational therapy not only with special educational needs and special education, but also with inclusive regular education. It is also necessary to develop models that allow generating the route to guide professional practice in the different Latin American and Caribbean educational contexts. The development of models in countries such as Colombia and Venezuela respond to the history and context of each of these countries. In other countries such as Brazil, some groups of researchers speak of models such as radical inclusion, which although not shared by the entire profession, allows them to visualize their own realities. These examples reflect the need to create models for each geographic and historical context, which could consider general philosophical, social, humanistic and therapeutic guidelines for the region.

Another challenge is related to the training of professionals in this field, an area that highlights the need to strengthen academic and continuing training in occupational therapy in the educational field. It is recommended, for example, that the available bibliography regarding the history of occupational therapy be linked to the training processes of occupational therapists, as well as the reflections and experiences generated at the university level by Murillo et al. (2023), and other experiences with ethnic groups, with victims of the armed conflict, with individuals who reintegrate into society, with populations living on the borders; care mediated by telehealth and those with new proposals in the area, so that there is more knowledge on these topics allowing these contributions to the profession to be made visible (Moreno-Chaparro et al., 2022).

A final challenge is associated with the need to generate greater knowledge that contemplates the realities of each country in the region, favoring collaborative research and including evidence-based practice. To promote this idea, the establishment of support networks between professionals and the dissemination of good practices is required, this being one of the main functions of the TOE Community of Practice, which is reflected in this research.

Limitations

Although this article describes the state of occupational therapy in education in Latin America and the Caribbean, understanding its scope, challenges and opportunities in the region, it must be considered carefully. This is because the contributions of individuals were analyzed within the framework of a community of practice and under particular parameters, so what is described represents a perspective of the reality of each of the countries involved. In addition, what is described by the contributors of each country may be influenced by their own experiences, which is essential to consider in communities of practice, but at the same time they can influence the information shared and analyzed in this research.

In addition, the time frame in which this study was carried out and its publication must be considered, since the presentations analyzed were developed in the first half of 2021, so the information shared may be different today. This responds to the dynamism and dynamics of the educational context, which constantly varies according to the history and legislation of each country.

Acknowledgements

To the TOE Community of Practice of Latin America and the Caribbean, especially to the contributors who participated voluntarily in the many instances required to fulfill the objective of this research. The participation of members from: Chile, Argentina, Bolivia, Colombia, Peru, Brazil, Venezuela, Mexico, Costa Rica and Panama is noteworthy.

  • 1
    Legislation from Colombia and Chile were considered according to the place where the authors of this article work, either as academics or professionals in occupational therapy.
  • 2
    The information shared by members of Brazil considered the thesis name: TERAPIA OCUPACIONAL NA EDUCAÇÃO: Composição e Delineamentos do Campo Profissional (Batista de Souza, 2021).
  • How to cite:
    López Díaz, C., Parra-Esquivel, E, & Salazar Rivera, J. (2024). Occupational therapy in education in Latin America: an analysis from the Occupational Therapy in Education (TOE in Spanish) Community of Practice. Cadernos Brasileiros de Terapia Ocupacional, 32(spe), e3925. https://doi.org/10.1590/2526-8910.ctoAO392537992

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Edited by

  • Section editor
    Prof. Dr. Magno Nunes Farias

Publication Dates

  • Publication in this collection
    06 Dec 2024
  • Date of issue
    2024

History

  • Received
    09 Mar 2024
  • Reviewed
    06 May 2024
  • Accepted
    05 July 2024
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