ABSTRACT

Rehabilitation services in education settings are evolving from pull-out interventions focused on remediation for children and youth with special education needs to inclusive whole-school tiered approaches focused on participation. A limited number of discipline-specific practice models for tiered services currently exist. However, there is a paucity of explanatory theory. This realist synthesis was conducted as a first step towards developing a middle-range explanatory theory of tiered rehabilitation services in education settings. The guiding research question was: What are the outcomes of successful tiered approaches to rehabilitation services for children and youth in education settings, in what circumstances do these services best occur, and how and why? An expert panel identified assumptions regarding tiered services. Relevant literature (n = 52) was located through a systematic literature review and was analysed in three stages. Several important contextual characteristics create optimal environments for implementing tiered approaches to rehabilitation services via three main mechanisms: (a) collaborative relationships, (b) authentic service delivery, and (c) reciprocal capacity building. Positive outcomes were noted at student, parent, professional, and systems levels. This first-known realist synthesis regarding tiered approaches to rehabilitation services in education settings advances understanding of the contexts and mechanisms that support successful outcomes.

摘要

教育环境中的康复服务正在从侧重于对有特殊教育需求的儿童和青少年进行补救的拉出式干预，演变为侧重于参与的包容性全校分层方法。目前存在数量有限的分层服务的特定学科实践模型。然而，缺乏解释性理论。这种现实主义的综合是作为在教育环境中发展分层康复服务的中程解释理论的第一步。指导性研究问题是：在教育环境中为儿童和青少年提供康复服务的成功分层方法的结果是什么，这些服务在什么情况下最好发生，以及如何发生和为什么发生？专家小组确定了有关分层服务的假设。相关文献（n = 52）通过系统的文献综述定位，并分三个阶段进行分析。几个重要的背景特征通过三个主要机制为实施康复服务的分层方法创造了最佳环境：（a）协作关系，（b）真实的服务提供，以及（c）互惠能力建设。在学生、家长、专业和系统层面都取得了积极成果。这种关于教育环境中康复服务分层方法的第一个已知的现实主义综合促进了对支持成功结果的背景和机制的理解。