School-Based Occupational Therapy in Inclusive Education: A Scoping Review of Roles, Practices, Contexts, and Gaps
TL;DR
The studies showed that occupational therapy practitioners support students, teachers, and school systems through individual intervention, classroom-based support, consultation, environmental adaptation, capacity building, and advocacy, and point to the need for stronger collaboration, clearer service models, and broader attention to students’ participation across school life.
Abstract
Importance Literature on school-based occupational therapy in inclusive education remains dispersed and variable, obscuring how occupational therapy practitioners support collaborative learning environments. Objective To map existing evidence on the roles, practices, contexts, and gaps of school-based occupational therapy in inclusive education. Data Sources We searched Google Scholar, GALE, PubMed, ScienceDirect, ERIC, EBSCOhost, CINAHL, and Scopus for English-language literature published between 2010 and 2025. Study Selection and Data Collection We reported the review in accordance with PRISMA-ScR and conducted it using the Arksey and O’Malley framework, refined by Joanna Briggs Institute guidance. We screened primary studies on occupational therapy in inclusive education, charted data, applied qualitative content analysis, and did not conduct critical appraisal. Findings The review included 60 studies, primarily utilizing qualitative designs (56.7%) from high-income regions. Occupational therapy practitioners were described across individualized direct-service, collaborative, consultative, capacity-building, and systems-level roles. Practices included skill-focused supports, embedded and tiered service-delivery approaches, environment- and participation-focused strategies. Implementation occurs in mainstream primary schools (55.0%), with fewer studies in early childhood and secondary, transition and higher education contexts. Persistent barriers hindering inclusive practice include educator role ambiguity, high caseload models restricting shared planning time, and overemphasis on structured academic tasks over nonacademic occupations. Conclusions and Relevance School-based occupational therapy in inclusive education is broad, context-dependent, and represented across collaborative, embedded, and participation-focused forms of practice. Advancing this area requires clearer role communication, attention to service location and delivery models, structural support for collaboration, and broader attention to participation across academic and nonacademic school routines. Plain-Language Summary Inclusive education requires schools to support students of all abilities across classroom and everyday school routines. We reviewed 60 studies published from 2010 to 2025 to map how occupational therapy practitioners contribute to inclusive education. The studies showed that occupational therapy practitioners support students, teachers, and school systems through individual intervention, classroom-based support, consultation, environmental adaptation, capacity building, and advocacy. Most studies focused on primary and elementary schools, with fewer studies in early childhood, secondary, transition, and higher education settings. The review also identified important gaps, including unclear understanding of occupational therapy roles, high caseloads, limited planning time with teachers, and less attention to nonacademic activities such as play, recess, and social participation. These findings highlight occupational therapy's important role in supporting inclusive school participation and point to the need for stronger collaboration, clearer service models, and broader attention to students’ participation across school life.