“It Changed My Perspective”: Embedding Occupational Therapy Within an Early Childhood Education Centre Provides Inclusive Developmental Support and Access to Early Intervention

ABSTRACT

Background

Early intervention (EI) provides critical support to young children with developmental delays, aiming to optimize their development and learning readiness. However, studies have shown that 74% of eligible children never receive a referral for EI services. This pilot study explored the impact of the Occupational Therapy Embedded in Early Childhood (OTEEC) Partnership Model, where providers support all children enrolled at a childcare centre, on young children's access to developmental support in the context of early childhood education.

Methods

We used a case study approach to explore parent, teacher and administrator perspectives on a 10‐week pilot trial of embedded occupational therapy within an early childhood education centre. We collected data through pre‐implementation surveys and post‐implementation focus groups with centre administration, teachers and parents. We compared children served through traditional EI pre‐implementation with children supported during the embedded occupational therapy trial through record review.

Results

Survey and focus group data were analysed using thematic analysis. The findings reflected the three primary stakeholder groups and their related subthemes: children (you catch things early, the problem was getting solved, it makes more sense), parents (when should I be worried?, What is normal?, I feel more confident) and teachers (we had more of a relationship, it changed my perspective, my stress levels went down). Of the 80 enrolled children, four were receiving EI before the embedded occupational therapy trial. During implementation, we identified 26 who needed developmental support.

Conclusion

Embedded occupational therapy had a significant impact on the early childhood centre's ability to support young children's development and participation in learning. This study highlights the need to intervene at the systems level to create inclusive early childhood classrooms by focusing on helping teachers respond to early developmental concerns and empowering parents through access to developmental specialists.

Summary

• EI provides critical developmental and learning support to young children and their families, yet barriers exist for children with behavioural and mental health concerns or subtle developmental differences.

• Children of colour from families with lower socioeconomic resources are less likely than their White peers from middle to upper‐class families to receive a referral for EI, representing systemic inequities.

• The Occupational Therapy Embedded in Early Childhood (OTEEC) Partnership Model eliminates access barriers and qualification criteria by placing occupational therapists within early childhood education centres to serve all members of the early childhood community: parents, teachers, administrators and children.

• The OTEEC Partnership Model approach significantly changed the number of children receiving developmental support at the partnering early childcare centre and offered accessible support for teachers and parents.

• Parents and teachers preferred having an occupational therapist on‐site who was familiar with the children and routines of the centre and could offer in‐the‐moment suggestions.

1. Introduction

Birth through age 3 years is a critical developmental window in which children's neural plasticity is the greatest and most malleable to change. Developmental interventions provided to children 3 years and younger have a profound impact on children's long‐term developmental health and learning receptivity (Bodison 2021). Federal law requires states to offer early intervention (EI) programmes that identify, evaluate, qualify and serve children with known disabilities or risk factors for developmental delay (United States Department of Education 2023). However, McManus et al. (2020) found that providers refer only 18.7% of EI‐eligible children to EI, and only 26% of referred children receive services. Barriers to accessing EI services have been found within identification and qualification processes and disproportionately impact children of colour from low‐income families (McManus et al. 2020; Khetani et al. 2017; Feinberg et al. 2011).

Identification for EI relies on physicians, teachers and parents effectively monitoring children's development and detecting signs of developmental delays to initiate an EI referral. Gellasch (2016) found that paediatric primary care providers are most likely to notice children's developmental delays, yet many children lack a primary care paediatrician (Jabbarpour et al. 2024). Access to paediatric primary care reflects health disparities and is influenced by intersecting systemic and social barriers. Low parental health literacy, challenges navigating healthcare systems, procedural difficulties with obtaining appointments, inadequate provider communication and parental mistrust of providers result in underutilization of primary paediatric care (Koball et al. 2021; Fahey et al. 2024). Families affected by socioeconomic factors such as poverty, minority status, lack of insurance and rural location are less likely to access paediatric primary care than suburban White families with average to above‐average means (Crouch et al. 2024; Slopen et al. 2024; Leininger and Levy 2015).

Early childhood education providers (e.g., teachers or childcare staff) are theoretically well‐positioned to monitor children's development and recognize developmental delays. However, teachers report that the demands of custodial caregiving leave little time for them to reflect on children's development and explore concerns (Chödrön et al. 2019). Chödrön et al. (2019) found that when teachers do identify a developmental concern with a child, one in six are unfamiliar with their State's developmental support system and referral process. Unlike public school teachers, early childhood teachers lack consistent child development training and education requirements and may work in childcare centres without procedures for monitoring children's development (Chödrön et al. 2019). Sun et al. (2024) further found that post‐pandemic stress and trauma reactions have skewed young children's developmental trajectories, making it more challenging for teachers to discern developmental concerns from behavioural dysregulation.

Parents also have a responsibility to monitor their child's development and recognize concerns, yet parents report a range of competency in enacting this role. Sapiets et al. (2021) found that factors such as parental educational level, family economic status, familiarity with child development and childhood disability, and ethnicity and cultural backgrounds influenced the extent to which parents reported developmental concerns. Parents complete the Ages and Stages Questionnaire during well‐child visits as a primary part of developmental screening, yet this assessment is inherently subjective and influenced by caregivers' health literacy and confidence in reporting their child's abilities (Connery et al. 2023). Physicians may also discount family perspectives on their child's development and rely more on clinical observations when vetting developmental concerns (Behrens et al. 2022). Parents may feel discouraged and disempowered when they bring their concerns to paediatricians who dismiss their insights.

State‐mandated qualification requirements that determine a child's eligibility for EI services influence young children's access to services. For example, a child in Colorado only qualifies for EI services if they have a delay of 25% or more in at least two developmental domains or 33% delay in at least one developmental domain as measured by a State‐approved developmental test, an approved diagnosis associated with a developmental delay, or a child who lives with a parent with a diagnosed developmental disability (Early Intervention Colorado 2023). Children who have subtle developmental delays or those with behavioural or mental health concerns are not eligible for services unless they have a co‐morbid developmental delay. Meng and Wiznitzer (2024) estimate that 19% of children aged 2–8 years have at least one mental health disorder. Teachers report concerns that young children's mental and behavioural health is not adequately screened or treated in early childhood (Kumar et al. 2023).

Systemic barriers within EI have long‐term impacts on children's readiness for school. Turnbull et al. (2022) found that nearly half of children from socioeconomically disadvantaged backgrounds are unprepared for school at age five. Exposure to adverse experiences and a lack of developmental support in early childhood impacts literacy, motor skills, self‐regulation and social–emotional functioning (Manfra 2019; Ramakrishnan and Masten 2020; Turnbull et al. 2022). The significant increase in technology use and resulting decline in outdoor play and peer engagement in childhood further impacts developmental trajectories (Konca 2022). EI can aid in negating these impacts through interventions that target children's development, support mental and behavioural health, promote engagement in important childhood occupations and enhance supportive parenting routines (Jasmin et al. 2018; Leadley and Hocking 2017).

The Occupational Therapy Embedded in Early Childhood Education (OTEEC) model aims to provide a more accessible and integrated form of EI services through direct partnership with early childhood education centres (ECECs) (Fyffe 2024). The OTEEC Partnership Model embeds occupational therapists within ECECs, supporting all children, staff and parents in the context of the child's natural environment. The OTEEC Partnership Model emphasizes collaborative partnerships with all members of the ECEC community best to integrate support into the children's daily routines. Inclusive and preventive support, as well as early detection, are crucial aspects of this model, enabling a shift from reactionary practice and reducing the need for more intensive interventions in the future (Fyffe 2024).

This manuscript reports findings from a pilot study exploring the impact of the OTEEC Partnership Model on an ECEC's access to EI and developmental support. The purpose of this study was to (1) understand what impact, if any, the embedded model of occupational therapy had on children's access to EI services and (2) describe the perspectives of early childhood teachers, administrators and parents on having access to an occupational therapy provider in the context of early childhood education.

2. Methods

We conducted this qualitative study from August 2024 through November 2024. The Colorado State University Institutional Review Board approved this study (Approval # 6042).

2.1. Study Design

We followed Yin's (2018) exploratory case study approach to examine parent, teacher and administrator perspectives on the embedded occupational therapy model. An exploratory case study design is appropriate when the researchers seek to retain a holistic and real‐world perspective on an organizational phenomenon. (Yin 2018). For this study, we defined the ‘case’ as an early childhood centre community where teachers, administrators, parents and children share a collective educational experience. We defined the phenomenon as the presence of an embedded occupational therapy programme and explored how this changed the centre's access to developmental support and EI.

2.2. Setting

This study took place at an ECEC (subsequently referred to as ‘the centre’) in Northern Colorado, serving 278 children aged 6 weeks to 5 years. The centre has 12 classrooms divided by age group; this study engaged the infant and toddler classrooms only. The centre offers a sliding fee scale to support families with lower incomes; 28% of enrolled children are from low‐income households, 14% from single‐parent families, four children receive the Child Care Assistance Program, 12 children qualify for sliding fee tuition, and nine families report English is their second language (Arabic and Spanish are the first languages).

2.3. Participants and Recruitment

We invited 157 parents with children enrolled in the infant and toddler classrooms to complete the surveys and join the focus groups. Parents of children receiving EI prior to the study were invited to join either a focus group or complete an individual interview (for privacy); one parent chose the individual interview. We invited teachers working in infant and toddler classrooms, along with the centre administration team, to complete the surveys and join focus groups. Eighteen parents, 17 teachers and six administrators completed the surveys, and 10 parents, 12 teachers and six administrators attended focus groups. Focus group participant demographic information is presented in Table 1.

TABLE 1.

Participant demographics.

Participant group: administrators (n = 6) and teachers (n = 12)
Role at centre	Time worked at this centre	Time worked in early childhood settings	Highest educational degree earned
Executive director	24 years	30 years	Bachelor's
Assistant director	8 years	9 years	Bachelor's
Assistant director	21 years	24 years	Bachelor's
Communication specialist	7 years	13 years	Master's
Enrollment coordinator	8 months	3.5 years	Bachelor's
Scheduling coordinator	6 years	9 years	Bachelor's
Infant teacher	3 years	10+ years	Associate
Infant teacher	1 year	1+ years	Associate
Infant teacher	3 months	3 months	High school diploma
Infant teacher	12 years	16 years	High school diploma
1‐year‐old teacher	1 year	2 years	Bachelor's
1‐year‐old teacher	6 months	3 years	High school diploma
1‐year‐old teacher	3 years	10+ years	High school diploma
1‐year‐old teacher	2 years	5 years	High school diploma
2‐year‐old teacher	1.75 years	1.75 years	Bachelor's
2‐year‐old teacher	5 months	5 months	Associate
2‐year‐old teacher	4 years	10 years	Associate
2‐year‐old teacher	2.5 years	5 years	High school diploma

Participant group: parents (n = 10)
Parenting role	Child's classroom	Highest educational degree earned	Employment status	Relationship status
Mother	1‐year‐old	Doctorate	Full‐time	Married
Mother	Infant	Master's	Full‐time	Married
Mother	1‐year‐old	Bachelor's	Full‐time	Married
Mother	1‐year‐old	Master's	Part‐time	Married
Father	1‐year‐old	Bachelor's	Full‐time	Married
Mother	1‐year‐old	Master's	Full‐time	Married
Mother	2‐year‐old	Bachelor's	Full‐time	Married
Mother	2‐year‐old	Master's	Full‐time	Married
Mother	Infant	Master's	Full‐time	Married
Mother	2‐year‐old	Master's	Full‐time, student	Married

2.4. Data Collection

We collected data in three phases (pre‐implementation, implementation and post‐implementation) over 12 weeks. Surveys and centre data review were the primary pre‐implementation data sources; therapist documentation and reflective journaling were the primary implementation data sources, and focus groups were the primary post‐implementation data sources.

2.5. Pre‐Implementation

We distributed an online survey to the key stakeholder groups (parents, teachers and administrators) associated with the infant and toddler classrooms to understand how stakeholders were conceptualizing early child development and engaging resources to support children. We developed separate yet parallel survey questions for parents and teachers/administration to elicit their specific expertise in these areas. See Table 2 for a sampling of survey questions.

TABLE 2.

Sampling of pre‐implementation survey and post‐implementation focus group questions by participant groups.

Data collection phase	Sample questions for parents	Sample questions for administrators and teachers
Pre‐implementation surveys	Have you ever had any concerns about your child's development?	How often do you have developmental concerns with the children in your classroom or centre?
	If you ever had concerns about your child's development, how would you go about seeking support?	When you have developmental concerns about a child in your classroom or centre, what do you do?
	How familiar are you with the early intervention system in Colorado?	Please describe your experience with referring children for early intervention.
Post‐implementation focus groups	Can you give us an example of an interaction or observation that made you wonder if your child was on track with their development?	What have you found to be the most important aspect of early childhood development that predicts whether an infant or child will be successful in your classroom or centre?
	What support do you need as a parent to feel confident in your child‐rearing?	What actions do you take when you notice a child is struggling developmentally or behaviourally in your classroom?
	What impact, if any, has the occupational therapy programme had on you and your child?	How has your experience with embedded occupational therapy differed from your experiences with traditional early intervention services?

2.6. Implementation

We implemented a 10‐week trial of embedded occupational therapy following the procedures described in Fyffe's (2024) OTEEC Partnership Model. First author AB was embedded in two infant and four toddler classrooms, totaling an average of 44 h of embedded support per classroom. Aligned with the OTEEC Partnership Model's principles, AB supported all children, teachers and parents through extended classroom time, interprofessional collaboration and knowledge sharing. AB collaborated with teachers to enhance all children's development and learning through inclusive and enriching environments and activities (universal support), offered individualized support to children needing tailored plans to engage in learning or develop well (targeted support) and consulted with families whose children needed care outside of the centre due to medical or developmental needs (consultative support). We define each level of support and provide example interventions in Figure 1.

FIGURE 1.

Comparison of development support needs pre‐implementation and post‐implementation of the OTEEC Partnership Model trial by classroom.

2.7. Post‐Implementation

Pre‐implementation survey data informed the post‐implementation focus group interview protocols, which used open‐ended questions to elicit parents, teachers and administrators' perspectives on child development and access to developmental supports during the early childhood years. We conducted five focus groups with participants grouped by their role at the centre; this resulted in two parent groups, two teacher groups and one administrator group. One individual interview was completed with a parent following the same parent interview protocol. We obtained written consent from each participant prior to completing surveys and conducting interviews. All interviews were audio recorded using voice recorder and transcribed using Rev transcription software. See Table 2 for a sampling of focus group questions by participant groups.

2.8. Data Analysis

We completed thematic analysis in phases, including: an open read of the transcript for familiarization and to record any biases or assumptions, preliminary hand coding to identify recurring concepts, organizing data excerpts along conceptual clusters and then identifying themes through comparative analysis. We completed this process separately for each group of participants: parents, teachers and administrators. We completed data reduction and thematic refinement until we reached a consensus on clearly defined and well‐supported themes. We maintained an audit trail and conducted reflexive journaling throughout the data analysis process. Additionally, we met weekly to cross‐check our processes, thereby enhancing the study's validity and trustworthiness.

2.9. Quality Assurance

We took many steps to optimize the integrity of our research processes. We triangulated our findings through data trial audits, met weekly to discuss potential codes and wrote research memos to track all analytic decisions. We practised highly disciplined subjectivity through reflective journaling and by constructing interview protocols with open‐ended questions to elicit participants' perspectives. We discussed our biases and assumptions across the research cycle and acknowledged our dual role as researchers and providers.

2.10. Positionality

The first author, AB, was an occupational therapy doctoral capstone student working under the direct supervision of the second author, LF, during this study. LF is the author of the OTEEC Partnership Model, has worked as an occupational therapist since 1999 and has partnered with ECECs on embedded occupational therapy models since 2015.

3. Findings

The embedded occupational therapy trial involved 80 children and 18 teachers across six classrooms serving infants and toddlers. Prior to embedded occupational therapy, four children at the centre were receiving occupational, physical or speech therapy through EI or home health. Through embedded occupational therapy, we identified 26 children with developmental or behavioural health needs significant enough to warrant occupational therapy in the context of their classrooms, and we referred three of these children for additional medical services outside of the centre (i.e., paediatrician evaluation for oral or spinal structures due to concerns with tongue‐tie or scoliosis). See Figure 1 for an illustration.

Parents, teachers and administrators found value in the embedded occupational therapy approach. We describe three primary categories and subthemes to illustrate the impact of embedded occupational therapy on the children, parents and teachers at an ECEC community; see Table 3.

TABLE 3.

The major subthemes of each category are defined and illustrated.

Themes	Subthemes	Definitions	Illustrative quote
Children	You Catch Things Early.	Recognizing support needs early.	I think sometimes for the one‐year‐olds at least, it's tricky to pinpoint when we need extra support.
	The Problem Was Getting Solved.	Addressing concerns immediately.	Having [Embedded Occupational Therapist] in the room with us, she was seeing our concerns, and the problem was getting solved right then.
	It Makes More Sense.	Reflecting on embedded support.	If the goal is functioning in a classroom, it makes more sense to receive those services in the classroom.
Parents	When Should I Be Worried?	Uncertainty monitoring development.	There are many challenges with developmental stages and comparing to your child and then as a parent managing anxiety and scheduling.
	What Is Normal?	Parents' knowledge gaps.	The pediatrician always has that development quiz [ASQ]. I always get worried about filling that out. I'm like, is she picking things up with two fingers?
	I feel more confident.	Practical and affirming support.	The practical piece is so huge. She wasn't like, you need to do all these crazy things. These practical little things can really make a huge difference.
Teachers	We Had More of a Relationship.	Valued collaborative partnership.	Being here has allowed [embedded occupational therapist] to form relationships with everyone, which I think removes some barriers.
	It Changed My Perspective.	Changed teaching practices.	I feel like we are better able to adjust to problems more than we were before because we can learn from [embedded occupational therapist].
	My Stress Levels Went Down.	Decreased teacher stress.	Being able to go to parents and we can help the situation. I think it eases the conversation a lot to already have solutions.

3.1. Children

The theme Children represents the perceived impact of the embedded occupational therapy trial on meeting the developmental needs of children from the perspective of teachers and administrators. Participants highlighted the early detection of developmental concerns, collaborative problem‐solving and universal support. We describe three sub‐themes illustrating these findings below.

3.1.1. You Catch Things Early

Administrators described the importance of recognizing early signs of developmental concern to initiate support and prevent compounding concerns as children age. Teachers noted that the embedded occupational therapy provider helped them interpret children's development and navigate support needs. ‘I'm more aware in the classroom of things I should pay attention to’, one teacher stated. Teachers believed the embedded occupational therapy presence enhanced their ability to recognize signs of developmental concern. Teachers and administrators felt that embedded occupational therapy was a proactive way of addressing emergent developmental concerns in younger classrooms. They described how failing to address minor concerns in the infant and toddler rooms leads to greater concerns in preschool.

We catch things early that we might not have caught because [Embedded Occupational Therapist] is here. We can pick her brain about something we're noticing, rather than waiting to see, and avoid a major concern when the child is three or four. Administrator Focus Group, Speaker 6, p.22

3.1.2. The Problem Was Getting Solved

Teachers and administrators reflected on the challenges they have faced in obtaining classroom support after identifying a developmental concern in their classrooms. Teachers valued embedded occupational therapy for ‘in‐the‐moment’ collaboration and support strategies. Administrators described the challenge of long wait times (up to 6 weeks on average) when accessing outside developmental support for children. Administrators and teachers valued immediate access to the embedded occupational therapist, who could respond to a concern the same day.

Before we had [Embedded Occupational Therapist], it took four to six weeks, start to finish, to get help. So, that's four to six weeks of the child and the teacher struggling, and their threshold of tolerance is shrinking more and more. Administrator Focus Group, Speaker 4, p. 16

3.1.3. It Makes More Sense

Teachers and administrators felt that one of the most important aspects of embedded occupational therapy was the support provided to all children, regardless of the severity of their developmental needs. They explained that EI therapists are limited in time and only work with an identified child who qualifies for services, saying, ‘It's just not the same level of support when you have a provider coming in to do their job, then going to the next client somewhere else.’ Teachers and administrators believed the embedded model destigmatized developmental support and promoted children's sense of comfort and belonging.

You cannot compare embedded occupational therapy to other developmental supports. It is honestly night and day. When a child gets pulled out of a classroom, there may be little sense of I am different. And when there is embedded OT, they do not feel like they're different. Administrator Focus Group, Speaker 5, p. 21

3.2. Parents

The theme Parents represents the perceived impact of the embedded occupational therapy trial on parents. Parents described challenges with monitoring their children's development, given the pressures of working full‐time, receiving limited guidance during well‐child visits and a lack of clarity on developmental expectations. We identified three sub‐themes that illustrated parents' experiences; we describe these below.

3.2.1. What Is Normal?

Parents with single and multiple children described the uncertainty they felt in monitoring their children's development. Parents believed their limited knowledge about early child development impacted their ability to discern developmental trends within their children. Parents focused on more concrete developmental skills, such as walking, talking and feeding, and assumed their child's teacher would tell them if their child's social or cognitive development was a concern. Parents also reported a lack of knowledge about play, cognition and social development, which limited their competency in monitoring these developmental areas. One parent stated, ‘I feel like people don't know the different types of play skills and what you're supposed to be looking for at certain ages’. Another parent described how they rely on their child's teacher to monitor these areas of development.

I'm not concerned with play skills, socialization, or things like that. I have confidence in the school and the teachers to be on top of that and to form my kids beneficially. I'm not as concerned because they're in a place that's filled with caring professionals who know what they're doing. Parent Focus Group, Speaker 6, p. 7.

3.2.2. At What Point Do I Ask Someone?

Parents shared moments when they felt overwhelmed and sought immediate guidance on understanding their child, but did not know who to turn to for support. Parents also felt conflicted about their experiences with well‐child visits and wondered about the validity of the developmental questionnaires they completed before each paediatrician appointment. One parent spoke of her anxiousness waiting for a well‐child appointment, saying, ‘I have a huge list when I see my doctor, all my concerns, and the appointments never seem to come soon enough’.

Parents compared their experiences with well‐child visits to the access they had to an occupational therapy provider during the embedded occupational therapy trial. Parents appreciated the opportunity to have immediate conversations with an expert who knew their child well. Parents found the embedded occupational therapy approach of extended time in the classroom and sharing information readily with parents to be affirming and helpful.

Having the OT here has been huge, and the information has always been non‐shameful. That has been helpful as a parent because guilt and lack of confidence are just there daily. I felt really empowered. Here's one thing I can do, and it's not a shame. Parent Focus Group, Speaker 2, p. 10.

3.2.3. I Feel More Confident

Parents whose children had worked directly with the embedded occupational therapist described the benefits they perceived in incorporating simple suggestions at home and at the centre. Parents' perspectives on developmental support shifted as they embraced the power of making adjustments to their daily routes and interactions. Parents emphasized their need for practical, affordable and accessible support to help them navigate both the early childhood years and the situational challenges that arise as children work through developmental stages and transition into classrooms with more complex expectations. One parent remarked, ‘It's real life, it's functional, it's people with them every day. It just should be that way because parents aren't supposed to know all these things.’ When asked to describe the impact of receiving support at their child's early childcare centre, parents spoke of their appreciation for the presence of trained professionals within their child's school. They described the barriers they would face if they had to seek support elsewhere. ‘We are all working parents’, one parent said. ‘Navigating schedules, and time off from work, and I would not know who to call if someone wasn't here.’ Another parent noted that seeking support outside her child's centre would likely mean delaying the conversation due to the challenges she would face.

At the end of the day, I'd just think to myself, ‘I'm not going to do that.’ I will wait for the next well‐child check, which is few and far between when they get older. Removing those barriers and not having to jump through all of the hoops is huge for me. Parent Focus Group, Speaker 10, p. 11

3.3. Teachers

The theme Teachers describes the perceived impact of the embedded occupational therapy trial on teachers and administrators. Administrators and teachers believed embedded occupational therapy changed teachers' views, practices and experiences supporting young children's development and learning. We describe four sub‐themes illustrating teachers' experiences below.

3.3.1. We Had More of a Relationship

Administrators believed the immediate access to an embedded occupational therapy provider allowed teachers to discuss children in their classrooms at the onset of concerns. Teachers preferred the more collaborative relationship cultivated with the embedded occupational therapist in comparison to EI therapists working with individual children in their classrooms. Teachers appreciated being more involved with children's support and appreciated the ecological relevance of support plans developed within the classroom context.

[Embedded Occupational Therapist] would collaborate with us, but I've had some EI therapists come in to work with a specific child. They just come in without talking to us, so we don't even know. We weren't sure where to step in or how we could help further. So, it was nice getting to talk and bounce ideas back and forth [with the Embedded Occupational Therapist]. Teacher Focus Group 2, Speaker 5, p. 18

3.3.2. It Changed My Perspective

Teachers reflected on how embedded occupational therapy changed their views and practices in their roles supporting children. One teacher expressed, ‘I definitely look at things differently now.’ Teachers also felt they were more equipped to effectively respond when concerns arose in children's development, which they attributed to the embedded occupational therapists' modelling of tools and strategies. Teachers felt more empowered when monitoring children's development and more confident when interpreting children's daily actions and behaviours.

One of the most significant impacts was that it changed my perspective on a lot of the things the kids were doing. Seeing what [Embedded Occupational Therapist] was noticing and doing with those kids was something I never would have thought to notice in a kiddo. Teacher Focus Group 2, Speaker 3, p. 21

3.3.3. My Stress Levels Went Down

Teachers believed that having an occupational therapist embedded in their classrooms reduced their stress levels. One teacher added that having new strategies to try was supportive, indicating ‘the more things we know how to try, the more it keeps us from feeling helpless.’ Teachers further appreciated having a knowledgeable partner for communicating concerns with parents, a task teachers described as especially challenging. Teachers found value in partnering with the embedded occupational therapy provider to present parents with concerns and suggestions.

When children have developmental concerns, that takes up a lot of space in our heads and adds a lot of stress to our plates. Having someone consistently in the room who is focused solely on finding solutions was a big burden off our shoulders. Teacher Focus Group 2, Speaker 3, p. 24

Administrators further reported that they observed positive changes in their teachers' stress levels. One administrator said, ‘It's amazing. Having the [embedded occupational therapist] here definitely helped my teachers manage stress and be more willing to try things.’ Administrators further discussed how they believe embedded occupational therapy expanded their teachers' threshold and capacity for supporting children in their classroom.

4. Discussion

Findings indicate that embedded occupational therapy significantly increased children's access to developmental support, empowered teachers and parents through collaborative partnerships and offered children with behavioural challenges or subtle developmental delays a path for intervention. See Figure 2 for a graphic illustration of the findings, which shows the hypothesized relationships between children's development, participation in daily classroom life, and parent and teacher empowerment.

FIGURE 2.

Illustration of the impact of embedded occupational therapy on the early childhood centre community, including children, families and educators.

Several factors contributed to the success of the OTEEC Partnership Model's trial. First, parents and teachers emphasized the need for strong relationships with EI providers, such as occupational therapists. Relationships were valued as a mechanism for mutual respect, shared understanding and collaborative problem solving and allowed for more nuanced discussion of individual children's classroom experiences given post‐pandemic challenges discerning developmental concerns from behavioural regulation (Sun et al. 2024). Second, the extended presence of the occupational therapy provider in the early childhood classrooms destigmatized teachers asking for help and created an opportunity for the occupational therapy provider to intervene. Chödrön et al. (2019) found that teachers have little time to explore developmental concerns, therefore, the occupational therapy providers presence in the classroom enabled more children to be identified and supported. Third, the occupational therapy provider's recommendations were grounded in the routines and interactions of the classroom and family, which Bodison (2021) found to be most impactful.

The embedded occupational therapy model fostered an inclusive developmental support system at the ECEC. Having immediate access to a developmental specialist familiar with the children and classrooms at the centre decreased the stress administration and teachers feel when addressing developmental concerns with parents. Kumar et al. (2023) found that teachers are highly concerned with the lack of developmental, behavioural and mental health support in early childhood. Participants in this study felt the embedded occupational therapy model provided immediate solutions when children were challenged by group learning. Teachers stated that having occupational therapy embedded in their classrooms decreased their stress levels and provided them with new perspectives and strategies, increasing their capacity to support children.

Identification is the biggest barrier to receiving EI services (McManus et al. 2020) so placing a provider within an early childhood centre allowed more children to be identified and supported quickly. Best practice in EI is to support children at the onset of developmental concerns. However, sluggish identification and referral systems fail to identify children until their developmental needs are severe. Bringing EI support to the early childhood centre eliminated many of the barriers families and teachers face when seeking developmental support, thus a broader range of children were served.

Sapiets et al. (2021) described health disparities given variance in parent's health literacy and competence, and this was reflected in participants perspectives. Parents were more likely to monitor concrete developmental skills (e.g., walking, talking and feeding) because these skills were emphasized at paediatrician visits and included in the Ages and Stages Questionnaire. Teachers were more concerned with children's social–emotional functioning and self‐regulation and felt these skills were less intuitive for parents to observe. Throughout the embedded occupational therapy trial, the embedded occupational therapy provider was able to monitor each of these areas of development, detect new concerns and facilitate teacher and parent discussions, thus enhancing collaboration and communication between the home and school environments.

Members of the early childhood centre community concluded that embedded occupational therapy allowed for the timely recognition of children's developmental concerns, immediate action to support children's development and learning, and improved teacher and parents' ability to monitor children's development and learning. Further, embedded occupational therapy provided in the context of the classroom helped to capture what children need to be successful in the school environment in preparation for preschool and kindergarten. These findings highlight the importance of continued efforts to implement systemic changes to EI practices and expand access to providers in ECECs.

5. Limitations

This study offers an in‐depth examination of how embedded occupational therapy impacted children's access to developmental support at an ECEC. We further describe the perceived advantages that administrators, teachers and parents reported in having access to an occupational therapy provider in the context of daily classroom life. The findings of this study inform policies guiding access to developmental support, including EI, and providers may reflect upon the value of situating EI in the context of classroom routines. However, as a qualitative study, the findings are not intended for broad generalization outside of the research context and represent the experiences of the centre where the study was conducted.

Author Contributions

Alexis Bedard: data curation, formal analysis, investigation, project administration, writing – original draft. Lisa Fyffe: conceptualization, formal analysis, investigation, methodology, supervision, validation, writing – review and editing.

Funding

The authors have nothing to report.

Disclosure

All materials and text contained in this submission are original works; therefore, the authors have no reprint permissions to disclose.

Ethics Statement

This study was approved by the Colorado State University Institutional Review Board (Approval # 6042). All participants signed a consent form approved by the Colorado State University Institutional Review Board before participating in this research project.

Conflicts of Interest

The authors declare no conflicts of interest.

Bedard, A. , and Fyffe L.. 2026. ““It Changed My Perspective”: Embedding Occupational Therapy Within an Early Childhood Education Centre Provides Inclusive Developmental Support and Access to Early Intervention.” Child: Care, Health and Development 52, no. 1: e70223. 10.1111/cch.70223.

Data Availability Statement

The data used to inform the findings of this study are available by request on a case‐by‐case basis to protect participant privacy.