Homeschool Educators Perspectives about Student Needs within Occupational Therapy Scope of Practice: A Pilot Study

Home School Researcher                  Volume 38, No. 2, 2022, p. 1-7

PDF click here (All tables and graphs are available in the PDF.)

Susan L. Iliff

Associate Professor, Department of Occupational Therapy, Belmont University, Nashville, Tennessee, sue.iliff@belmont.edu

Mary T. Hill

Lecturer II, Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, New Mexico, mthelanderhill@salud.unm.edu

Rose White

Occupational Therapy Student, Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, New Mexico, rosie7831@gmail.com

Aubrey Alexander

Occupational Therapy Student, Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, New Mexico, elena.aubrey@gmail.com

Abstract

Homeschool educators (n = 31) were recruited to complete an electronic survey describing their perspectives. Findings indicated that many students had medical/academic needs, and accessed additional services such as occupational therapy (OT). Data analysis of open-ended questions revealed common categories: (a) curricula met or did not meet student needs (b) participants had experience-based, general or no knowledge of OT and (c) most felt homeschooling was a positive experience and expressed that limited resources were available. Further research is warranted to investigate available resources, specific needs, and how to best support students who homeschool.

Keywords: Children, Occupational Therapy, Homeschool, Community-Based Practice.

Introduction

Occupational therapy addresses the physical, cognitive, psychosocial and sensory components of performance (AOTA, 2017). Pediatric occupational therapy (OT) is commonly practiced in traditional academic settings, as well as in the community for early intervention with clients and families in their home (AOTA, 2020). The role of OT for families who homeschool their children is a setting in which there is presently a paucity of research. Previous studies have primarily focused on the outcomes of socialization for children who were homeschooled compared to those in traditional school settings (Medlin, 2015). The purpose of this pilot study was to explore the perspectives of homeschool educators related to medical and or academic needs of their children and use of curricula or additional services.

The U.S. Department of Education’s National Center for Education Statistics (NCES) reported that 1.69 million children were homeschooled in 2016 and 2.5 million students were homeschooled in 2019 (Ray, 2021). In homeschooling, students receive a majority of their education outside of public or private education systems by a parent or guardian (Ray, 2021; Neuman & Oz, 2021). School districts are not required or prohibited from providing special education or related services to students with disabilities who are homeschooled (Taylor, 2020).

The available research base does describe some perspectives of families who homeschool in relation to decision making, benefits to the homeschool educator, and the student(s). Families who choose to homeschool do so for a variety of reasons including religious preferences, environmental concerns, and special needs of the child (Wang, Rathbun, & Musu, 2019). Families who homeschool prize flexibility in scheduling (Pannonne, 2017). Vaughn et al., (2015) found that students who were homeschooled were less likely to report use of tobacco, alcohol, or illicit drugs. Additionally, research supports positive findings in the sleep patterns of children who are homeschooled (Meltzer et al., 2014). Other families value the development of home-educator associations for sharing curricula and camaraderie (Tilhau, 2020). Many parents of students with disabilities express higher satisfaction with the special education while homeschooling than parents whose children attend public, religious, or private school (Cheng, Tuchman & Wolf, 2016). 

Role of Occupational Therapy in Homeschooling

Occupational therapy practitioners (OTPs) currently work with students who are homeschooled in outpatient, private practice, and community-based settings. OTPs have an established and essential role in supporting educational outcomes. OTPs collaborate with parents and caregivers and other professionals to identify and meet the needs of children experiencing delays or challenges in development. OTPs identify barriers that interfere, restrict, or inhibit functional and educational performance (AOTA, 2017). This may involve modifying activities, materials, and the environment so children can participate under different conditions and in various settings (e.g. home, social groups, sports, and community programs). OTPs also teach and model skills and strategies to students, their families, and other significant individuals in their lives to extend therapeutic intervention to all aspects of daily life tasks (AOTA, 2017). This exploratory survey study sought to examine the experiences of homeschool educators and the medical and or academic needs, and curricula and additional services used by their children. The research questions are as follows:

1. Do homeschool educators know about and/or access OT?
2. What are the medical and or academic needs of child(ren) who are homeschooled?
3. Do the homeschool curricula meet the students’ medical and or academic needs?
4. What else would homeschool educators express about their experiences?

Methods

Participants

The research team used snowball convenience sampling to recruit participants (n = 31). Recruitment occurred via social media posts, local homeschool education resource centers, and in-person recruitment efforts at a state-wide homeschool conference. Recruited participants were encouraged to forward the study link to other homeschoolers in their sphere of influence. Included participants were current homeschool educators who could read and write in the English language and who had access to the internet to complete the online survey. Participants were excluded if they were not current homeschool educators or could not read or write in the English language, or who did not have access to the internet. Though most participants were recruited from one southwestern state, there were no specific geographic, cultural, or ethnic inclusion or exclusion criteria.

Research Design and Procedures

The Institutional Review Board at the University of New Mexico approved the study (Study ID: 16-362) and informed consent was obtained from each participant prior to data collection. The study used an exploratory survey design that examined the quantitative group characteristics and qualitative experiences of parents who homeschool to meet the medical and or academic needs of the children they homeschooled.  A survey design was used because the study team was cognizant of limited time availability for homeschool educators. The team also hoped that the online survey would foster increased recruitment so that the results would be informed by more data. 

A recruitment email, including a flier and the study consent form, was sent through the Research Electronic Data Capture System (REDCap, 2019).  A secure web address to the consent form and the anonymous survey were disseminated through electronic mail or social media (Harris et al., 2009). The research team obtained informed consent from participants before the completion of the electronic survey.

Instrumentation

The electronic survey consisted of 23 open and closed ended questions. Survey questions were constructed by research team members who were licensed OTs experienced with intervention and assessment for children who are homeschooled. All survey questions were optional and the total survey was designed to take no more than 30 minutes. Figure 1 [All tables and graphs are available in the PDF.] displays the full list of survey questions.

Data Collection and Data Analysis

Data were securely collected and managed via REDCap. All de-identified data entered in REDCap was downloaded to a spreadsheet application for ease of analysis. Descriptive and quantitative data were summarized to understand participant and student characteristics. The research team used a qualitative thematic analysis approach during three different group analysis sessions to examine and re-examine the data for emerging categories (Nowell et al., 2017). Each session was an iterative and reflective process that involved a constant shifting between the different phases of analysis. Such phases included generating initial categories, exploring and reviewing categories, and defining patterns to reveal conclusive results (Nowell et al., 2017).

In order to establish trustworthiness and rigor in the study, a homeschool educator, who had approximately three-years of experience in homeschooling, served as a member checker to ensure credibility at two out of three analysis sessions. The member checker was selected due to her proactive involvement in the homeschool community as well as her medical background which provided a firm basis for her to bridge understanding between medical and homeschool perspectives as well as to challenge study assumptions. These insights contributed to the understanding of the overall themes, thereby strengthening the findings of the study. Prolonged engagement by the research team with the de-identified data has resulted in further rigor as the team has questioned their assumptions about the data over time (Nowell et al., 2017). Trustworthiness was also enhanced by investigator triangulation where several research team members along with the member checker read through the de-identified data separately and came together to complete the data analysis and develop categories (Carter et al, 2014).

Results

Quantitative Survey Data

The majority of the participants (homeschool educators) were mothers and homeschooled one to three children who ranged in age from one- to 14-years old.  Table 1 summarizes the study’s participant and student demographics and characteristics. [All tables and graphs are available in the PDF.]

Participant Curricula Used, Student Needs and Services Accessed

A large majority of participants used more than one curricula in homeschooling. 38% of the participants reported diagnoses and needs affecting student performance.  The most frequent diagnoses were mental health conditions, developmental delays (including autism, and sensory integration differences.  Participants indicated that a diagnosis such as impulse control and behavior as well as executive function skills such as time management and organization affect homeschool performance.  Participants reported accessing OT or other services through private insurance (71%) or other means including out of pocket expense (29%). Table 2 displays the curricula, educational needs, and services used by the participants and their students

Homeschool Educator Perspectives

Homeschool Curricula

Participants responded to open and closed-ended questions about their use of structured curricula. They described curricula related to a general, religious, or classical education as well as multi-sensory educational needs. Another survey question asked how the curricula were, or were not, meeting the needs of the students. Two primary categories emerged: meeting student needs or not meeting student needs. Participants who described curricula as meeting student needs indicated the curricula were effective for their students’ learning styles and easy to implement. Conversely, study participants who felt the curricula were not meeting student needs described frequent curricular changes to accommodate for medical, social, or mental health needs of the student. Table 3 displays participant quotations supporting the categories.

Knowledge of and Use of Services

Participants were also asked what they knew about OT. The three categories identified were: experience-based, general knowledge, and no knowledge. Participants who described experience-based knowledge (33%) indicated that they have worked with an OTP to support the learning needs of their students. Participants who described general knowledge (57%) gave some descriptive details of the OT profession without indicating any personal knowledge or experience. Few participants expressed no knowledge (10%) of OT. Supporting quotations for these categories are in Table 3.

Homeschool Educator Experiences

The final survey question was purposely open-ended to capture all possible perspectives and asked: What else would you like us to know about your experiences as a homeschool educator? Two primary categories emerged: positive experience and limited resources. Many participants expressed sentiments that fall into both categories.. Participants valued the adaptability and flexibility allowed through homeschooling. Conversely, participants reported limitations in specific resources such as finances, tools and time in order to meet their students’ educational needs. Quotations demonstrating these categories are also in Table 3.

Discussion

This pilot study examined the perspectives of homeschool educators related to the medical and academic needs of their children. In addition to collecting sample demographics, the survey questions allowed study participants to describe the needs of their students, available curricula, and the social and therapeutic services used. Study findings confirmed previous literature findings that homeschool educators instruct students with special needs and value flexibility to make swift curricular decisions (Wang, Rathbun, & Musu, 2019; Pannone, 2017). Confirming results by Tilhau (2020), homeschool educators reported using numerous curricula to meet the educational needs of their students.

Study findings revealed that the students had a variety of health conditions (such as mental illness and developmental disabilities). Participants indicated unmet needs (such as executive function differences) for which OT evaluation and treatment may be reasonable and necessary.  Most participants who indicated they accessed OT services did so through private insurance with the remainder largely using private pay. A vast majority of  participants had definition-based or experience-based knowledge of OT. 

Based on our findings, homeschool educators appear to contact and use various educational support services, such as OT, for support of academic performance and use private insurance or private funding to access the services.  OT has a responsibility to identify and meet the ever-changing occupational needs of families who homeschool and offer skilled intervention in the students’ natural environment. Though the study data was collected prior to the COVID-19 pandemic, it is important to note that more families are considering homeschooling as a result of the pandemic (Musaddiq et al., 2021).  Preliminary reports from the United States Census Bureau (2021) indicate that parents report homeschooling at twice the rates of pre-pandemic levels. With the increase of families homeschooling, our findings indicate that homeschool educators know about occupational therapy and may access it to meet the medical and academic needs of their children.

Limitations and Future Directions

Limitations in the study included a small sample (n = 31), hailing exclusively from the southwestern United States. The survey only requested responses from one parent. For two parent households, there may have been multiple perspectives, which limited the overall data of the study. All participants had to have English language, digital literacy and access to internet infrastructure to complete an online survey. In the southwestern state from which many participants were recruited, there is a strong digital divide that inhibits Native American tribal members from participating in online studies (Sanchez, n.d.). These factors limited generalizability and participant representation in the study.

Another limitation is that researchers deliberately shortened the survey to encourage completion; out of consideration for parental privacy, the demographic questions were specifically limited in the survey design. This survey design may have reduced the depth and breadth of investigation which could have been enriched by the use of focus groups for data collection and member checking. The survey was also not piloted prior to use. Clinical experiences and personal background of the research team may have biased the development of survey questions and interpretation of the responses. The study also would have benefitted from incorporation of multiple member checkers who have varying years of experience and/or backgrounds and perspectives to better inform instrument development and analysis and study findings.

In the future, studies incorporating larger sample sizes and more survey questions involving post-covid (2020 and beyond) are warranted since more students have participated in learning at home related to emergency pandemic orders (Grisham, 2020).  Further studies that include recruitment strategies to include homeschool educators from more geographic regions and that allow responses in electronic or non-electronic means would improve generalizability of data about academic and medical needs of students who are homeschooled.  Survey questions about specific medical diagnoses as well as where and how homeschool educators access OT and other services, and what types of services are lacking, may guide homeschool communities and service providers to collaborate and meet the medical and academic needs of students who are homeschooled.  Gaining information about whether the students’ medical diagnoses of developmental disabilities (such as autism) was a motivating factor for the parents’ choice to homeschool may direct intervention and programming from OTPs and other service providers. Further research on how funding limits or promotes access to additional services may further inform homeschool communities and service providers about possible unmet needs.

Conclusion

This pilot study revealed perspectives of homeschool educators. Most participants have at least some understanding of the definition or scope of practice for OT. Many participants indicated they received OT to meet their students’ educational needs. Those students had medical or educational needs that are within the OT scope of practice. Participants were using numerous different curricula; some were designed specifically to meet sensory or academic needs of the students. Consolidating best practices for OT in the homeschool setting would be a resource to OTs and to families seeking additional services. Participants expressed that homeschooling has been a challenging and rewarding experience. They also wish more resources, such as OT, were available. This exploratory survey begins to illuminate the experiences of homeschool educators and the medical and or academic needs, and curricula and additional services used by their children.

References

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

American Occupational Therapy Association. (2017). What is the role of the school-based occupational therapy practitioner? https://www.aota.org/practice/practice-settings/-/media/bb31f7706ab342a29e020560813a1dd5.ashx

Carter, N., Bryant-Lukosius, D., DiCenso, A., Blythe, J., & Neville, A. J. (2014). The use of triangulation in qualitative research. Oncology Nursing Forum, 41(5), 545–547. doi: 10.1188/14.ONF

Cheng, A., Tuchman, S., & Wolf, P. J. (2016). Homeschool Parents and Satisfaction with Special Education Services. Journal of School Choice, 10(3), 381–398. https://doi.org/10.1080/15582159.2016.1202076

Grisham, M. (2020). Executive Orders-004. Office of the Governor—Michelle Lujan Grisham. Retrieved on 10/29/2022 from https://www.governor.state.nm.us/about-thegovernor/executive-orders/

Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O’Neal, L., McLeod, L., Delacqua, G., Delacqua, F., Kirby, J., Duda, S. N., & REDCap Consortium (2019). The REDCap consortium: Building an international community of software platform partners. Journal of biomedical informatics, 95, 103208. https://doi.org/10.1016/j.jbi.2019.103208

Lau F. Chapter 13 Methods for Survey Studies. In: Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27. Available from: https://www.ncbi.nlm.nih.gov/books/NBK481602/Medlin R. Homeschooling and the question of socialization revisited. Peabody Journal Of Education, 88(3), 284-297. doi: 10.1080/0161956X.2013.796825  

Meltzer, L. J., Shaheed, K., & Ambler, D. (2016). Start Later, Sleep Later: School Start Times and Adolescent Sleep in Homeschool Versus Public/Private School Students. Behavioral sleep medicine, 14(2), 140–154. https://doi.org/10.1080/15402002.2014.963584

Mission, K, (August 12, 2020). Interest in homeschooling has “exploded” amid pandemic. The Associated Press. Retrieved October 6, 2020, from: https://www.mprnews.org/story/2020/08/12/interest-in-homeschooling-has-exploded-amid-pandemic

Musaddiq, T., Stange, K., Bacher-Hicks, A., & Goodman, J. (2021). The Pandemic’s Effect on Demand for Public Schools, Homeschooling, and Private Schools. 2021, 1-7. Retrieved on 7/31/2022 from https://edpolicy.umich.edu/sites/epi/files/2021-09/pandemic_effect_sept2021_final.pdf