CO-OP-based school occupational therapy in Japan: a mixed-methods study within the Partnering for Change (P4C) model

Background Occupational therapy (OT) remains uncommon in Japanese educational institutions. This study examined a school-based OT program that integrated Cognitive Orientation to daily Occupational Performance (CO-OP) within Partnering for Change (P4C). Methods A convergent mixed-methods study was conducted across three public elementary schools and included 936 students across 39 classes. Tier 1 Universal Services reached all students; Tier 2 Targeted Services reached 19 unique classes (an estimated 490 students); and 15 students received Tier 3 Individualized Services. Canadian Occupational Performance Measure (COPM) ratings were averaged within students for the participant-level analysis ( N = 15). Interviews with five educators were analyzed using reflexive thematic analysis and then integrated with quantitative findings. Results Mean COPM Performance scores increased from 4.8 (SD 1.8) to 7.8 (SD 2.0) ( p < .001, r = 0.85), and Mean COPM Satisfaction scores increased from 5.1 (SD 2.4) to 7.7 (SD 2.5) ( p = .001, r = 0.82). Five themes addressed strategy-based reframing, perceived school-wide agency, specialist consultation, collaboration with parents around children's goals, and contextual limits on strategy use. Integration showed convergence at Tier 3; broader perceived effects varied with leadership, goal ownership, emotional regulation, and group size. Conclusions The program was associated with improved individual outcomes and perceived benefits extending beyond individual support. The uncontrolled design and absence of standardized Tier 1 and Tier 2 outcomes limit conclusions about the program's effectiveness and school-wide impact.