Graduation Year

2025

Document Type

Capstone

Degree Type

Open Access Capstone

Degree Name

Doctor of Occupational Therapy (OTD)

Department

Occupational Therapy

Abstract

Background: In Kentucky public schools, occupational therapists are employed as classified staff without access to educator credential pathways. This study explores occupational therapist’s perceptions of how those state-level structures impact recognition, collaboration, leadership, and day-to-day practice within the educational system context. Purpose: This qualitative descriptive study examines school-based occupational therapists’ perceptions of how the absence of educator credential pathways influences their professional practice, collaboration, and leadership in Kentucky public schools. Research objectives focus on describing Kentucky school-based occupational therapists’ perceptions of leadership opportunities as shaped by state educator credentialing. Objectives also focus on exploring how credentialing influences interprofessional collaboration with educators and administrators. Theoretical Framework: The Canadian Model of Occupational Participation (CanMOP) guided the study, foregrounding how micro (individual), meso (organizational), and macro (policy) environments shape occupational therapists’ participation and opportunities in school systems practice. Methods: Using a qualitative descriptive design, 11 semi-structured virtual interviews were completed with licensed occupational therapists employed in Kentucky public schools with greater than 3 years of experience. Interviews were audio-recorded, de identified, and transcribed verbatim. Analysis conducted with manual thematic analysis blending deductive CanMOP informed codes (micro/meso/macro) with inductive codes to capture emergent themes. Rigor strategies included member checking, peer debriefing, reflexive journaling, thick description, and an audit trail. Results: Eleven Kentucky school-based occupational therapists described an interlocking system of barriers created by exclusion from educator credential pathways. Four themes emerged including structural career ceilings, pay inequities, and inconsistent classification; persistent medical-model perceptions that limit recognition as educational professionals; invisible workload and generic evaluation systems that fail to capture occupational therapy contributions, placing the burden of advocacy on individual practitioners; and a trade-off between valued autonomy and lack of formal influence. Together, these themes demonstrate how credentialing gaps constrain occupational therapists’ participation, leadership, and collaboration across micro, meso, and macro levels. Conclusions: The study concludes that Kentucky’s current policies restrict occupational therapists’ full integration as specialized instructional support personnel and leaders in MTSS and systems-level initiatives. Establishing optional educator credential pathways, aligning evaluation and pay structures with advanced training, and formally embedding occupational therapy within educational planning would recognize therapists as educational professionals, promote equity and workforce sustainability, and better leverage their expertise to advance access and outcomes for all students.

Faculty Mentor

Shirley P. O'Brien, Ph.D., OTR/L, FAOTA

Department Affiliation

Occupational Therapy

Committee Member

Allen Keener, PhD, OTD, OTR/L, ATP

Department Affiliation

Occupational Therapy

Department Affiliation

Occupational Therapy

Comments

I am grateful for the many people and communities who supported this work.

Thank you to Dr. Shirley O’Brien for her honest feedback, steady support, and guidance at every step. Thank you to Dr. Allen Keener for his thoughtful ideas and encouragement. Thank you to my Applied Leadership Experience mentor for her support and practical advice.

I am very grateful to the Kentucky school-based occupational therapists who shared their time and experiences. Their voices are the center of this project. I also appreciate the Kentucky Occupational Therapy Association and other advocates whose work helped shape this project.

To my husband, Timmy, and my daughter, Reagan, thank you for your love, patience, and encouragement. To my parents, thank you for always supporting and guiding me. Thank you to my extended family and friends for cheering me on, listening to my ideas, and celebrating each small step.

Above all, I thank God for giving me the clarity to start, the strength to keep going, and the courage to finish.

IRB Approval Number (if applicable)

006692

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