All students have the right to education. Students with disabilities need support from health providers to achieve their potential at school. Barriers to health service provision exist including shortages of providers, waitlists for services, complexities of coordination between the health and education sectors, and more recently the COVID-19 pandemic. Given these barriers, some schools have been using telehealth to increase access to school-based health services; however, the literature is still emerging in this area. In this thesis, I used scoping review methods to explore the literature pertaining to telehealth use in schools. The first manuscript describes the characteristics of telehealth use in schools as depicted in 57 included articles. The findings elucidated who is providing services using telehealth and with whom, when they are using telehealth, how they are using telehealth, and why they are using telehealth in the schools. Based on the findings, I identified practice and research recommendations. The second manuscript delves into the factors that influence telehealth use in schools. We used diffusion of innovations theory to categorize statements in the 57 included articles to identify factors that influenced telehealth implementation in schools. These categories included the features of the telehealth itself (the innovation), the communication about telehealth, the process of deciding to use telehealth (time), and the social system. The findings pointed to at least four key factors that influence implementation of telehealth in schools. The final concluding chapter integrates the findings from the two studies with overarching ideas about technology complexity, access to services, and current knowledge. Additionally, implications for schools, health providers, and specifically occupational therapists are provided along with policy implications. / Thesis / Master of Science Rehabilitation Science (MSc) / School-based health providers experience barriers to servicing children and youth. These barriers reduce access to services. Telehealth is a way to provide services that may increase access to health services in schools. This thesis explored the current research about telehealth use in schools. The first study looked at the characteristics of use such as who is using telehealth, how are they using telehealth, and why are they using telehealth. The second study looked at what factors influence use of telehealth in the schools. The findings from these two studies describe what is currently known about telehealth use in schools. With this information, health providers can decide when, with whom, and how to provide telehealth in the schools. Researchers may use these studies to fill gaps in knowledge about how to best use telehealth in the school setting.

This thesis explores the concept of family engagement in education and school-based rehabilitation services and contributes to practice and policy implications. / In pediatric occupational therapy, family-centered service is an essential part of practice. Working with families, occupational therapists facilitate capacity-building to enable parents to participate in their child’s occupational therapy services and make informed choices to best support their child. Family engagement can be particularly challenging in the school-based context, but without this engagement, services are at risk of being less meaningful and impactful for children. In this thesis, I explore the unique nature of the educational context, contribute to the conceptual development of ‘family engagement’, provide an in-depth analysis of family engagement in school-based occupational therapy, and generate stakeholder-informed solutions for occupational therapy practice. The first manuscript depicts a concept analysis that critically analyzes the concept of family engagement as discussed in the education literature. I suggest implications for professionals working with families and children in educational settings, including a proposed definition to contribute to further concept development. In the second manuscript, I present a qualitative description study exploring occupational therapists’ experiences on the development of family-therapist relationships using the Partnering for Change service delivery model. Through analysis of the data, I identify several factors influencing family-therapist relationships and recommend strategies to improve relationship-building. In the last study, I present an interpretive description study exploring family engagement in school-based occupational therapy services from the perspectives of both occupational therapists and families. Based on the findings, I recommend service transformation to improve family engagement, and to increase the value of these services for children and their families. Specific strategies for therapists, organizations, schools, regulatory colleges, and professional practice groups are outlined in this thesis to facilitate family engagement in school-based occupational therapy practice. Ensuring families are able to engage in services may lead to more individualized and impactful services in the school setting. / Thesis / Doctor of Philosophy (PhD) / Pediatric occupational therapists aim to partner with the family in all aspects of a child’s service. However, this is difficult for school-based occupational therapists. Families are not typically present at the school when therapists provide services for children, making it difficult to build relationships. This thesis explores factors that impact on how families are able to engage in the school-setting, and on how to provide families with better support. The first study examines how families engage in children’s education, and what this means for school-based therapists. The second study explores therapists’ views of what influences family-therapist relationships in a school-based service delivery model called Partnering for Change. The final study explores family engagement in school-based occupational therapy from the perspective of both families and therapists. Findings from all three studies contribute to a better understanding of what family engagement means in the school-setting, and how to build stronger family-therapist relationships in school-based occupational therapy services.