Occupational Therapy Consultation in Out-of-School-Time Care (Gakudo-Hoiku): A Case Report on Supporting a Child With Impulsive Behavior and Enhancing Staff Partnership

This case report aimed to clarify the intervention process and effectiveness of occupational therapist (OT) consultation in Japanese out-of-school-time childcare (Gakudo-Hoiku). The intervention focused on a school-aged girl who exhibited impulsive outdoor bolting and difficulty remaining indoors due to sensory-seeking behaviors. The participant was a third-grade elementary school girl without a formal medical or developmental diagnosis. The intervention was conducted from April 2023 to January 2024, with monthly consultation visits lasting approximately four hours each. The OT used a collaborative consultation approach that included explaining the child’s developmental and behavioral characteristics to childcare staff, proposing physical environmental modifications (e.g., installation of auxiliary door locks), and grading meaningful activities by assigning structured roles aligned with the child’s interests, such as assisting with picture-story shows (kamishibai). Physical environmental modifications were associated with a marked reduction in unannounced outdoor bolting, substantially decreasing the supervisory burden on staff. In addition, assigning roles based on the child’s interests promoted proactive participation during closing assemblies and facilitated positive interactions with peers. By functioning as a “clinical interpreter of behavioral characteristics” and an “environmental mediator” between the child and staff, the OT enhanced staff self-efficacy and contributed to the development of a sustainable support system within the childcare setting. OT consultation in Gakudo-Hoiku may play an important role in fostering inclusive environments and supporting the well-being of children with diverse developmental needs.