Partnering For Change

What is Partnering for Change (P4C)?

Partnering for Change is the name of both a new model for delivering integrated rehabilitation services for children with special needs and the program of research that has evaluated the development, implementation and evaluation of P4C service model. The P4C model of service is an innovative, collaborative, evidence-informed model that uses a needs-based, tiered approach to provide rehabilitation services for children with special needs in schools.

P4C was initially developed as a model of support for children with Developmental Coordination Disorder (DCD) because they were the largest group of children in Ontario who were on waitlists for School Health Support Services. Although this was the population of children first studied, the P4C model of service delivery has been shown to be of value for children with many diverse needs. 

P4C is a new way for occupational therapists to provide school-based services to children with special needs. Working collaboratively with educators and families, therapists provide support to whole schools and help create classroom environments that encourage successful participation and academic achievement of children. 

The development, evaluation, and implementation of this type of intervention required a partnership between researchers, the health care and school systems, the therapists who deliver services, and families.  In recognition of this need for partnership, we called the initial research project “Partnering for Change,” a name which was also adopted for the intervention and service delivery model.

The goals of the Partnering for Change service delivery model are to:

1. Facilitate earlier identification of students with special needs

2. Build capacity of educators and parents to understand and manage children’s needs

3. Improve children’s ability to participate in school and at home

​4. Facilitate self and family management to prevent secondary consequences

Click here for more information about P4C

The P4C Model

The Partnering for Change team used evidence from the literature to design a conceptual model that was tested in school settings and refined. This figure reflects the partnership between therapists, parents and educators to create physical, social and learning environments that facilitate successful participation for all students. Working from a foundation that focuses on relationship building and sharing of knowledge, these partners collaboratively implement universal design for learning principles to create environments that foster development in children of all abilities. They also screen and differentiate instruction for children who are experiencing challenges, even when universal changes have been put in place. Monitoring the response to these interventions allows therapists and educators to try individualized strategies and accommodations for students who need to participate in a different way. The school remains the target of intervention, allowing therapists to impact the greatest numbers of children. Therapists monitor each change and increase the intensity of the service that they provide as they coach educators and/or parents about those few students who have more complex needs. In this model, all collaboration and intervention occurs in the context of the classroom and other school environments.

P4C Research Studies


“P4C Pilot Project Pilot Project Demonstration Project Demonstration Project Knowledge Translation Knowledge Translation Implementation Implementation Summative Summative

Evidence-based management of disabilities in school-age children requires putting into practice the best and most current research findings, including evidence that early identification, self-management, prevention of secondary disability, and enhanced participation are the most appropriate foci of school-based occupational therapy. Partnering for Change (P4C) is a novel school-based intervention based upon these principles that has been developed and tested over an 8-year period using a community-based participatory action research (PAR) approach.

From the first pilot study, the research team recognized that transformation of school-based intervention for children could only occur through PAR, where there is true collaboration and partnership with the individuals and organizations who are responsible for implementing and sustaining change.  Studies of P4C were systematically conducted from this perspective [starting with a pilot project (2008-2009), demonstration project (2009-2011), to an implementation and evaluation project (2013-2015)].

P4C has involved stakeholders from Ministries of Health, Education and Children and Youth Services who are committed to use research findings to inform real-world change. 

Implementation, formative evaluation, and summative evaluation 2013-2015

From 2013-15, our team studied the evaluation and implementation of the P4C intervention in 40 schools across three different school boards and two different health care regions within Ontario. As in previous studies, PAR was still the foundation from which we approached working with community partners. In particular, we adopted an approach called integrated knowledge translation or IKT, which is defined as a process that enhances research uptake by guiding researchers and knowledge-users to work together throughout the research cycle to ensure the questions, methods, and findings are highly relevant to the health system.

The results were positive in all areas! Goals were achieved and the occupational therapy service was delivered in a way that identified children who were struggling earlier, reached many, many more children, built educator capacity and OT capacity, and cleared waitlists, at the schools receiving the P4C service, at no additional cost.  Click here for more information.

Sharing the Findings:

Campbell, W., Camden, C. & Missiuna, C. (2016). Reflections on using a community-based and multisystem approach to transforming school-based intervention for children with developmental motor disorders. Current Developmental Disorders Reports. Advanced online publication 29, March, 2016. DOI 10.1007/s40474-016-0081-y.  

Missiuna, C., Pollock, N., Campbell, W., DeCola, C., Hecimovich, C., Sahagian Whalen, S., …Camden, C. (2016). Using an innovative model of service delivery to identify children who are struggling in school. British Journal of Occupational Therapy. Advance online publication. doi: 10.1177/0308022616679852

Pollock, N., Sahagian Whalen, S., Dix, L., Campbell, W., & Missiuna, C. (2016) Shifting Occupational Therapy Practice in Schools to a Capacity-Building Model. Manuscript submitted for publication.

Campbell, W., Kennedy, J., Pollock, N., & Missiuna, C.  Screening children through Response to Intervention and Dynamic Performance Analysis: The Example of Partnering for Change. Current Developmental Disorders Reports, 1-6. doi:10.1007/s40474-016-0094-6 

Members of the P4C Research Team which sees occupational therapists deliver services and collaborate with educators - Hamilton Spectator

Research Team

Ontario Ministry of Health and Long Term Care. $994,600, 2013-2015. Implementation and evaluation of Partnering for Change, an innovative model that will transform health service provision for school-aged children with developmental coordination disorder. Missiuna, C. (PI), Pollock, N., Bennett, S., Camden, C., Campbell, W., McCauley, D., Gaines, R., & Cairney, J.

Ontario Ministry of Education, $199,810. 2015.Partnering for Change: An innovative service with relevance to the Special Needs Strategy.Missiuna, C. (PI), Hecimovich, C. (Principal Knowledge User), Bennett, S., Campbell, W., Pollock, N., Camden, C., Gaines, R., McCauley, D., & Cairney, J.

For more information contact:

KT 2011-2012

The P4C team received end-of-grant KT funding from the Canadian Institutes of Health Research (CIHR) to translate the findings from the demonstration study (2009-2011) to our stakeholders. Stakeholder involvement led to subsequent presentations for, and research proposals to, regional and provincial health care funders. Resource materials were developed for families and educators to use in the community and in schools. 

Research Team

Canadian Institutes of Health Research. $39,971, 2010-2012. Advancing an innovative model of service delivery: Partnering to promote knowledge exchange. Missiuna, C. (PI), Hecimovich, C., Bennett, S., Cairney, J., Gaines, R., Pollock, N., Campbell, W., & Levac, D.  

For more information contact:

Sharing our Findings

Pollock, N., Sahagian Whalen, S., Levac, D., DeCola, C., & Missiuna, C. (2013). Partnering for Change Online Course for Occupational Therapists (8 modules).

Missiuna, C., Polatajko, H., & Pollock, N. (2015). Strategic management of children with developmental coordination disorder. In J. Cairney (Ed.), Developmental Coordination Disorder and its Consequences (pp.215-252). Toronto, ON:  University of Toronto Press.

Rivard, L., Missiuna, C., Pollock, N., & David, K.S. (2011). Developmental coordination disorder (DCD). In S. Campbell, R.J. Palisano, & M.N. Orlin (Eds.), Physical Therapy for Children (4th ed.)(pp.498-538). St. Louis, MO: Elsevier.

DCD online workshop, originally designed for parents, but is useful for others as well including teachers, health professionals, coaches, family members and friends. (Offered in English and French)

DCD online workshop for Physiotherapists and Occupational Therapists (Offered in English and French)

Stakeholder Newsletters (2009-2012)

Partnering for Change Success Story – Using Integrated KT to Successfully Transform Health Service Provision for School-Aged Children with Developmental Coordination Disorder

Demonstration Study 2009-2011

In this project, researchers from CanChild partnered with decision-makers from the Mississauga-Halton Local Health Integration Network and with Community Rehab, providers of services for children with DCD. Using a participatory action approach to research, the team worked together with all stakeholders to plan and evaluate the feasibility of an intervention in which occupational therapists worked in 11 elementary schools and translated knowledge to help families and teachers better support children with DCD.

The study showed that educators, families and therapists all improved their knowledge about children with DCD and preferred P4C over current models of service delivery – Click here to read a summary of the study. 

Canadian Institutes of Health Research.  $199,994, 2008-2011.  Partnering for change (Demonstration Project): Promoting health and participation of school-aged children with developmental conditions in their communities.  Missiuna, C. (PI), Hecimovich, C. (Principal Decision Maker), Pollock, N., Russell, D., Cairney, J., Bennett, S., Ruttan, B. (Decision Maker), Gaines, R., & Rosenbaum, P. 

For more information contact:

Sharing our Findings:

Campbell, W., Missiuna, C., Rivard, L., & Pollock, N. (2012). “Support for everyone”: Experiences of occupational therapists delivering a new model of school-based service. Canadian Journal of Occupational Therapy, 79(1), 51-59.

Missiuna, C., Pollock, N., Campbell, W., Bennett, S., Hecimovich, C., Gaines, R., … Molinaro, E. (2012). Use of the Medical Research Council Framework to develop a complex intervention in pediatric occupational therapy: Assessing feasibility. Research in Developmental Disabilities, 33(5), 1443-1452. doi: 10.1016/j.ridd.2012.03.018.

Missiuna, C., Pollock, N., Levac, D., Campbell, W., Sahagian Whalen, S., Bennett, S.,… Russell, D. (2012). Partnering for Change: An innovative school-based occupational therapy service delivery model for children with developmental coordination disorder. Canadian Journal of Occupational Therapy, 79(1), 41-50. doi: 10.2182/cjot.2012.79.1.6.

A large group of stakeholders with a common concern came together to discuss P4C. This group was composed of families, educators, researchers, service providers and representatives from school boards, Community Care Access Centres, provider agencies, Ontario Ministries of Education, Children and Youth Services, and Health and Long-Term Care concerned about the challenges faced by school-aged children who have coordination problems. 

Stakeholder Alliance Symposium reports (2009-2010)

Stakeholder Newsletters (2009-2012) 

Pilot Study 2008-2009

A pilot project, funded by the Ontario Neurotrauma Foundation (ONF) and the Ontario Rehabilitation Research Advisory Network (ORRAN), was conducted to determine exactly what type of occupational therapy services should be provided in school to children with Developmental Coordination Disorder (DCD). There was recognition that research to transform school-based rehabilitation would require meaningful and ongoing engagement with the individuals, organizations, and systems who would be the ultimate end users of this knowledge. Meetings helped to identify what stakeholders viewed as the major challenges of the existing system and provided a forum in which to share ideas and to shape the research agenda with respect to developing and evaluating a new approach to intervention. A pilot study was mounted in 2 elementary schools and the intervention was discussed and refined at the symposia.

Ontario Rehabilitation Research Advisory Network.  $79,835, 2008-09.  Partnering for change (Pilot): An innovative school health service delivery model to improve access to rehabilitation services for children with developmental coordination disorder.  Missiuna, C. (PI), Pollock, N., Bennett, S., Russell, D., Gaines, R., Cairney, J., & Hecimovich, C.

For more information contact:

Sharing our Findings:

Missiuna, C., Pollock, N., Levac, D., Campbell, W., Sahagian Whalen, S., Bennett, S.,… Russell, D. (2012). Partnering for Change: An innovative school-based occupational therapy service delivery model for children with developmental coordination disorder. Canadian Journal of Occupational Therapy, 79(1), 41-50. doi: 10.2182/cjot.2012.79.1.6. 

Stakeholder Newsletters (2009-2012)

P4C/DCD Resources

Partnering for Change was initially developed to support children with Developmental Coordination Disorder (DCD). Several resources have been developed for children with DCD during the studies of P4C. These resources are available here and continue to support the use of the P4C service. 

DCD online workshop, originally designed for parents, but is useful for others as well including teachers, health professionals, coaches, family members and friends. (Offered in English and French)

DCD online workshop for Physiotherapists and Occupational Therapists (Offered in English and French)

Children with DCD:  At home, school and in the community (Booklet) 

M.A.T.C.H. Flyers: A Resource for Educators

DCD Educational Materials for Home, School, Physicians and other Health Professionals