Graduation Year


Degree Type

Open Access Capstone

Degree Name

Doctor of Occupational Therapy (OTD)


Occupational Therapy


Background: Formal handwriting instruction, using evidence-based, developmentally appropriate handwriting programming, in school based occupational therapy is necessary to support the role of a student. Handwriting is an occupation of children in the school environment. Without formal handwriting instruction in place there is evidence to support occupational therapy intervention providing a handwriting program can improve handwriting success.

Purpose: The purpose of this research study is to determine the clinical efficacy of a hybrid approach to handwriting instruction pairing the Handwriting Without Tears and Orton-Gillingham instructional programming for prewriting and handwriting skills in the kindergarten population. The research question addressed is: Will a hybrid intervention approach and collaborative efforts of the occupational therapist with the classroom teacher be effective in producing better handwriting outcomes vs. the traditional approach in the classroom setting?

Theoretical Framework. The Model of Human Occupation guided this research to understand volition and environmental factors of teachers, students, and parents to determine the extent in which these factors influence the occupational change.

Methods. A quantitative pretest/posttest design was utilized for this study. The Screener of Handwriting Proficiency-Kindergarten was administered pre and post, to a convenience sampling of kindergarten students to establish a baseline of prewriting and handwriting skills, followed by direct intervention each week and home reinforcement ideas for the parents to utilize. Several times weekly, the occupational therapist collaborated with the classroom teacher regarding needs and progress of students.

Results. The results revealed an extra-large effect size noted for both groups in the area of letter memory. For students with IEPs there was an extra-large effect size for letter memory and medium effect size for letter placement and size. Based on the data analysis of the pretest and posttest screeners it was determined that statically significant changes were not seen overall in this study. Despite not achieving statically significance there were clinically relevant changes noted via clinical observation in students writing outcomes.

Conclusions: Positive clinical outcomes were seen as a result of this study for children with IEPs within the intervention group, as well as positive teacher and student interactions with the OT. This study has opened the door for more open communication and changes for the school districts attention to handwriting instruction. Teachers across the district have also begun to inquire about handwriting instruction strategies; based on such a high request the district has asked the OT department to develop and present a professional development for our teachers at the beginning of the 2022-2023 school year.

Faculty Mentor

Julie Duckart, Ph.D., OTR/L

Department Affiliation

Occupational Therapy

Committee Member

Jennifer Hight, OTD, OTR/L

Department Affiliation

Occupational Therapy

Department Affiliation

Occupational Therapy



The completion of this Capstone Project would not have been possible without the support of my family and faculty and staff at EKU. I first want to thank my loving husband, Tyler, for his endless encouragement and support throughout my Capstone and OTD journey. I could not have made it without him pushing me to do my best every step of the way and his extra support at home as we gave birth to our first daughter, Leela. I would also like to thank Dr. Julie Duckart and Dr. Jennifer Hight, my capstone mentor and capstone committee member for their knowledge and insight throughout my research project. I have learned so much from these amazing Occupational therapists and have been inspired even more to pursue my dreams of being a professor one day. Lastly, I would like to thank my peers in the OTD program for all of the knowledge, experience, and expertise they have share with me over the past two years, I am a better OT for knowing each of you.

IRB Approval Number (if applicable)

Research Protocol Number #4221