Understanding school-based rehabilitation services through the lived experiences of children and youth with disabilities: a meta-aggregative review

Children and youth with disabilities continue to face barriers to accessing quality education, despite education being a key social determinant of health. School-based rehabilitation services (SBRS) include occupational therapy (OT), physiotherapy (PT), and speech-language pathology (SLP) that are delivered within the school context to address these barriers by promoting participation and inclusion. However, the implementation of SBRS has largely prioritized adult perspectives, with limited consideration of the lived experiences of children and youth with disabilities. Guided by the Joanna Briggs Institute (JBI) guidelines for meta-aggregation, this review synthesizes primary qualitative studies exploring the lived experiences of children and youth with disabilities who receive SBRS. Following a systematic selection process and critical appraisal, 13 studies were included. A total of 53 findings were extracted, grouped into 14 categories, and synthesized into six overarching findings. Specifically, children and youth reported that they want (i) therapists to increase their autonomy and agency by clearly communicating the purpose and goals of therapy and supporting their ability to make informed choices; (ii) therapists to adopt a holistic approach by addressing both social-emotional and functional needs; (iii) therapists who are knowledgeable, supportive, empathetic, and who advocate for their needs; (iv) therapy that is individualized, meaningful, enjoyable, and scheduled in a way that respects school routines, enhancing their participation in both therapy and broader school life; (v) therapy to help them build skills supporting social connection and inclusion at school; and (vi) therapy in which they set goals and develop new skills. Findings showed children and youth with disabilities want to be involved in their therapy and expect therapists to equip them with skills to participate, make decisions, and be included at school and in therapy. The findings have important implications for SBRS practice and policy, highlighting the importance of centering the voices of children and youth with disabilities. Attending to children's and youths' perspectives can help foster practices and policies that are inclusive, holistic, and child-centered, and supports the development of services that are meaningful, empowering, and promote full participation in school life.