Integrated School-Based Rehabilitation Services
What does the evidence say about P4C?
To date, three Ontario studies have informed the development and implementation of this framework: a pilot
project (2008-09) funded by the Ontario Neurotrauma Foundation; a Demonstration Project (2009-10) funded
by the Canadian Institutes of Health Research; and the current Implementation and Evaluation study (2013-
15) funded by the Ontario Ministry of Health and Long-Term Care.
The published results of the demonstration project showed that:
Educators made positive changes in their knowledge and skills, and were highly satisfied with the
service. The strategies they learned were practical and feasible; they felt greater confidence in being able
to identify children with motor difficulties and speak to parents about concerns; they reported carryover of
strategies to the next academic year (Missiuna et al., 2012b).
Parents were very satisfied with service and had a better understanding of their child’s needs. Parents
were better able to support their child by using strategies at home, adapting environments, and sharing
information with others (Missiuna et al., 2012b).
OTs reported a positive change in their beliefs, knowledge and skills. The therapists also indicated a
strong sense of professional growth in this role and reported a feeling of belonging to the school
community (Campbell et al., 2012).
The first year results of the current project showed that:
15 OTs offering service one day/week in 40 schools (1207 work days) provided:
o 385 educator in-services (formal and informal)
o 704 activities at the whole class level (Tier 1)
o 2980 opportunities to screen small groups of children or trial differentiated instruction (Tier 2)
o 3329 individual accommodation activities for 592 identified children, with knowledge about
how to manage the children’s issues shared with educators and families (Tier 3)
Elimination of wait lists occurred in most schools in which the P4C service was implemented.
What does this mean for integrated rehabilitation services?
The P4C framework supports all three identified goals of the Special Needs Strategy: early
identification, coordinated service planning, and seamless service delivery. In this model, health
professionals work with educators, right from school entry, to identify children who require support. Services
are coordinated with educators and provided directly in the classroom context, including in the new Full-Day
Kindergarten programs. Streamlined referral processes and ongoing monitoring, along with the regular
presence of the health professional in the school as a point of contact, ensure that children get the services
they need, when they need them. CanChild’s 7-year engagement with health and education partners in
developing the P4C framework is congruent with the vision articulated in “Achieving Excellence: A Renewed
Vision for Education in Ontario” to “work with provincial, regional and local education and health partners to
support optimal delivery of, and access to, services and ongoing health supports for children, youth and
families” (p.16) and to provide “learners the tools they need to reach their full potential, regardless of their
individual circumstances” (Ministry of Education, 2014, p.4).