https://orcid.org/0000-0003-1073-1977
Abstract
Background
Evidence-based information and communication technology (ICT) interventions to enhance school participation among students with special educational needs (SEN) are required.
Aim
To evaluate the impact of an ICT intervention on school participation among upper secondary school students with special educational needs.
Materials and methods
Data on 300 students’ assessments with the School Setting Interview (SSI), grades and school attendance were used in this quasi-experimental study, with a one-group pretest-posttest design. Descriptive and inferential statistics and effect size were used, as well as Rasch analysis to generate interval data on the students’ ordinal SSI ratings.
Results
In the ICT intervention (median time eight hours), 54% of the students received a tablet, and software concerned with planning and structure was received by 85%. After the ICT intervention, a significant decrease in perceived need for adjustments in school activities was found on a group level and 30% of the students improved their school attendance. Students who benefitted the most from the ICT intervention had few adjustment needs in school activities and no special educational support at baseline.
Conclusion
An ICT intervention is promising for improving school participation among upper secondary school students with SEN.
Participating in school is a human right [Citation1] and is a vital component of adolescents’ everyday life that influences their current and future health [Citation2]. In Sweden, school is obligatory from the child’s sixth year of life and during the subsequent ten years, until upper secondary school, which is voluntary. Nevertheless, the vast majority (98%) of young people enrol in upper secondary school as it is a needed qualification for enrolment in further studies and for employment. Thus, successful schooling is an urgent question for young people, especially if they have a disability and/or have special educational needs (SEN), i.e. a need for additional educational services or support to achieve the goals of education [Citation3]. Research indicates that the support students receive in school is suboptimal since upper secondary school students with SEN have higher rates of school absence than their peers [Citation4,Citation5] and are less likely to graduate from upper secondary school [Citation6,Citation7], which in turn negatively affects their establishment on the labour market and enrolment in higher education [Citation8].
As stipulated in the Swedish Education Act [Citation9], student health units should consider the students’ need for special educational support, as well as their medical, psychological and psychosocial well-being. Swedish upper secondary school students with SEN have been reported to experience that their need for support is not acknowledged and that traditional adjustments in school, such as extra support from a special educational teacher or a school assistant, is not always helpful [Citation10,Citation11]. Thus, to provide adequate and effective support for the diversity of students’ needs, new tools and methods may be needed. Accordingly, occupational therapy competence has been proposed to complement the services delivered by the student health units to enable school participation [Citation12–14], for example by bringing an occupational perspective when identifying and accommodating students’ needs in school activities [Citation12], as well as knowledge about person-environment adjustments and supportive technology [Citation15,Citation16]. Yet to date, little research exists on support aiming to improve school participation among students with SEN provided by occupational therapists [Citation17].
The rapid technological developments in recent years have provided information and communication technology (ICT), i.e. technological tools and resources used to transmit, store, create, share or exchange information [Citation18], that can support students with SEN in various school activities [Citation19]. Thus, ICT as support for students with SEN may provide new opportunities to increase their school participation since the ICT provides support in a variety of school activities and environments. Literature reviews [Citation20–22] have concluded that ICT, such as tablets and smartphones with different software and applications, are helpful for students with SEN because when such technology is tailored to the student, it can produce better educational outcomes, and lead to increased satisfaction with learning and improved quality of life. However, in their literature review, Istenic Starcic and Bagon [Citation23] concluded that thus far, research has often focussed on ICT to address specific difficulties, such as with reading, or has evaluated a particular type of ICT, stressing the need for studies of large samples using ICT as support in the mainstream classroom, and based on students’ perceived needs [Citation20,Citation22–25]. The effectiveness of ICT as support for students with SEN has been an urgent question for many years, yet its proposed effectiveness in increasing school participation for students with disabilities and/or SEN needs to be investigated further.
According to the International Classification of Functioning, Disability and Health (ICF), participation is influenced by the dynamic interaction between a person and environmental factors and is defined as “involvement in a life situation” [Citation2]. Recently, based on a systematic review by Imms et al. [Citation26], participation was proposed to comprise attendance, i.e. ‘being there’ (for example attending school), and involvement, the subjective ‘in the moment’ experience of participation, associated with how well the environment fits the individual [Citation26]. When environmental aspects related to the cognitive, physical and social demands of school activities are not in agreement with students’ perceived abilities it may negatively affect students’ participation [Citation10,Citation27–29]. This in turn, could partly explain why students with SEN may experience low well-being in school, are at a higher risk of dropping out of school [Citation30] and are reported as achieving lower grades [Citation31]. An adjustment, such as using ICT with specific software to meet students individual needs in school activities, such as in reading, writing or remembering things, has the potential to increase school participation among students with SEN [Citation19,Citation32].
The aim of the present study was to evaluate the impact of an ICT intervention on school participation among upper secondary school students with special educational needs. The following research questions were posed:
What ICT was implemented as support in school activities and what was the duration of the ICT intervention?
To what degree did students’ perceived need for adjustments in school activities decrease after the ICT intervention?
To what degree did students’ school attendance increase after the ICT intervention?
What characterised students who benefitted the most from the ICT intervention?
Method
Research design
This study was quasi-experimental, with a one-group pretest-posttest design [Citation33]. Data on students’ perceived need for adjustments in school activities, collected with the School Setting Interview (SSI) [Citation34], and questionnaire data on student characteristics and information about the ICT intervention was retrieved from two Swedish government projects. In addition, students’ grades and school attendance records were collected by the first author between 2016 and 2018. Ethical approval for the study was obtained from the Regional Ethics Board in Linköping, Sweden, study code 2013/409-31 and 2015/203-32.
The government projects
In order to investigate whether an ICT intervention could improve school achievements among students with SEN, the Swedish Institute of Assistive Technology (SIAT) was commissioned by the Swedish government to conduct two projects between 2011 and 2014. The aim of the projects was to implement ICT and complementary services by occupational therapists to cater for students’ perceived need for support in school activities. The third author (PhD) of this paper worked as a research consultant in both projects, involved in design, data collection and ethical issues in order to make sure the inclusion of students, the ICT intervention and the data collection had the quality to be used in future research. The two government projects included 12 regular public upper secondary schools with approximately 10,000 students from five purposively sampled municipalities. A consecutive sampling [Citation33] was applied to include participants, where teachers and other school staff (e.g. the principal) in selected schools recruited students who had shown inability to reach educational goals, difficulties in planning, problem-solving, conducting or finishing tasks, or high school absence. Guardians gave their written approval for participation in the government project before any students under 18 years of age were included. The projects using the same design included 647 students altogether. Each project had separately reported methods and descriptive results [Citation35,Citation36]. For those participants that had provided a written agreement (n = 549) to participate in research, data was unidentified by SIAT and provided to the research group.
ICT intervention
The ICT intervention was designed to cater for the students’ perceived need for adjustments in school activities. The use of ICT in school activities was hypothesized to improve the agreement between the demands of school activities and students’ abilities, affecting students’ prerequisites for attending school and being involved in school activities, which in this study together represent students’ school participation. All students were provided with the two main components of the ICT intervention: ICT devices and/or software, purchased and provided by the projects, and complementary services from professionals to implement and use the ICT as support in school activities. Professionals with past experience of working with ICT as support in activities, six occupational therapists and one special education teacher, were employed in the projects. The complementary services consisted of instructions, strategies and training in how to use the ICT as support in identified school activities. Based on the students’ perceived need for adjustments in school activities, identified in the SSI baseline assessment, an intervention plan was established. In a need-based and student-centred approach, the professionals cooperated with the student to individualize the ICT and its use as support in identified school activities. In addition to the main components, supplementary educational support, such as modification of school tasks or extra time with teachers, could be included in the intervention depending on students’ perceived need for adjustments. As the ICT intervention was tailored to the student, the specific content involving devices and software and the time with professionals varied. Thus, the ICT intervention could be described as complex [Citation37].
All professionals cooperated with school personnel and student health units during the intervention process. Students could contact technicians and teachers involved in the project to receive assistance with the ICT, including hands-on help with installing software and resolving technical issues. The ICT intervention had a duration of four to six months between baseline and follow-up assessments.
Intervention fidelity
The following measures were taken to ensure that the data collection and intervention procedure were consistent between the sites [Citation38]. To inform and prepare those involved in selected schools before the projects started, the project directors and professionals invited students, parents and school personnel at included schools to an information meeting concerning the project’s aim and content, common difficulties for students with SEN, and the use of ICT as a support in school activities. The hired professionals in turn, were educated in the ICT intervention and received training in the use and administration of the SSI assessment instrument [Citation34] and how to handle the project specific questionnaires. In addition, the researcher from the research group had consultations upon request with the professionals concerning the data collection procedure and the administration of the SSI.
Participants
For the 549 students who gave written consent to the research, the following inclusion criteria were applied: students being ≤20 years of age, attending a national programme, and having a perceived need for adjustments in school activities that was identified with the SSI at baseline and addressed with the ICT intervention, and evaluated with a SSI assessment at follow-up. Excluded students were over the age of 20 (n = 7), did not have an identified need for adjustments at baseline, addressed with the ICT intervention, and evaluated at follow-up (n = 163) and did not attend a national programme (n = 79). Thus, 300 students were included in the present study.
Data collection
Measurements of students’ attendance and involvement were collected, in accordance with the components of participation proposed by Imms et al. [Citation26]. Students’ subjective experience of involvement was represented in the data retrieved from the government projects collected in the interviews using the SSI, version 3.1 [Citation34], and project-specific questionnaires at baseline and follow-up. In this study, students’ grades represented an objective measure of involvement because grades were considered to reflect the schools’ perspective of students’ involvement in education. Attendance was measured objectively as students’ school attendance, i.e. being in class.
Data retrieved from the government projects
The School Setting Interview (SSI) [Citation34] is a student-centred assessment comprising an interview involving 16 different school activities to identify students’ need for adjustments in school. Included school activities represent activities the student encounters in school, both inside and outside the classroom, ranging from academic activities such as reading and mathematics, to non-academic activities such as break-time activities (see for a presentation of items). The SSI items are rated using a four-step rating scale, from rating 1 (unfit) to rating 4 (perfect fit), where rating 1 (unfit) and 2 (partial fit) indicate a need for new adjustments, and rating 3 (good fit) and 4 (perfect fit) indicate no need for adjustments. The concept of student-environment fit is used as the outcome in the SSI, representing the students’ perceived need for support in school activities based on the agreement between personal abilities and environmental demands of school activities. Psychometric studies have provided evidence of the validity of the SSI and have contributed to development of the assessment instrument [Citation39,Citation40]. A recent Rasch analysis provided support for the validity of the SSI (version 3.1) for students with SEN in upper secondary school [Citation41]. However, the evaluation of the SSI revealed that the rating scale had disordered thresholds [Citation41], which was accounted for in the present study concerning measures of student-environment fit.
Table 1. The rating of items in the SSI at baseline and follow-up, presented in descending order based on identified need for new adjustments (ratings 1 and 2 combined).
Questionnaires
The project-specific questionnaires developed in the government projects generated information on student characteristics, special educational support in school, and use of ICT in education at baseline. The follow-up questionnaire collected data on the ICT intervention, e.g. what ICT devices and software students had used. In addition, the amount of time professionals were engaged in the entire intervention process for each individual student was reported.
Complementary data on grades and school attendance
The first author collected complementary data from 2016 to 2018, depending on when the students graduated. Students’ final grades concerned the three core subjects English, Mathematics and Swedish. The registered school attendance at the baseline semester and the semester when the intervention was evaluated was collected. Contact with the school administration in the specific municipality was via e-mail and/or telephone, and at least three reminders were sent before the data collection was cancelled. Two schools dropped out and provided neither grades nor school attendance records (21%, n = 64). One school provided grades but no school attendance records as this information had not been stored after the students had graduated (18%, n = 55). Furthermore, internal drop-out of grades (16%, n = 49) and school attendance (12%, n = 37) occurred because of incomplete personal information on students, which prevented schools from searching for the requested data or because students had changed school or dropped out of school before graduation. The requested data was provided via e-mail, regular mail or by visiting the school. Grades were obtained for 187 (62%) of the students, and school attendance for 144 (48%) of them.
Data analysis
Analyses were performed using IBM SPSS Statistics (version 24) [Citation42]. Overall significance was set at a level of p < 0.05. Data on student characteristics, access to special educational support and use of ICT in education, obtained from the project-specific questionnaire at baseline was analysed with descriptive statistics using proportions, mean and median (Mdn). Differences in student characteristics (age, gender and diagnosis) between the present sample of 300 students and the 549 students who gave consent to research were investigated via Chi-square tests. The students’ grades in core subjects were dichotomized as ‘pass’ or ‘fail’ according to the criteria of the Swedish National Agency for Education. The students were categorized as ‘pass in all courses’ if they had achieved pass grades in all enrolled courses, or ‘fail’ if they had failed any grade.
To answer the first research question concerning what devices and software were used to cater for students’ perceived needs in school activities, and the duration of the ICT intervention, the data from the project-specific questionnaire at follow-up was analysed. The number and types of ICT devices and software used by students were grouped into the following categories: type of ICT device (e.g. laptop or tablet), ICT for planning and structure, ICT for writing and reading and other support. Descriptive statistics of range, mean, median (Mdn) and standard deviation (SD) were used to present the length of time the professionals were involved with students in the ICT intervention.
Research question two concerning the decrease in students’ perceived need for adjustments in school activities after the ICT intervention, involved analyses of data from the SSI assessments. The students’ ratings of SSI items at baseline and follow-up were summarized and are presented with proportions in , as well as the total distribution of ratings 1–4. Descriptive statistics were used to analyse the sample and determine the extent of perceived adjustment needs in school activities at baseline and at follow-up using mean and Mdn. On a group level, a Wilcoxon signed-rank test was used to test the difference between students’ adjustment needs in school activities at baseline and follow-up (ordinal scale). For the Wilcoxon test, the test statistic, denoted T, and its significance were reported. Effect size r was used to analyse the magnitude of the difference, expressed as small (0.10), medium (0.30) and large (0.50) effect size [Citation43].
To answer the third research question, concerning the degree to which students’ school attendance had increased, the registered school attendances at the baseline semester and at the follow-up semester were compared for the 144 students for which data had been collected. Based on the comparison, students’ school attendance was categorized as ‘decreased’, ‘same’ or ‘increased’ and presented with proportions.
To analyse what characterized students who benefitted the most from the ICT intervention (research question 4), analyses were performed in three steps. First, a Rasch analysis of students’ ordinal SSI ratings was performed. Ordinal SSI data was organized in a stacked (by assessment time point) format and analysed with the computer software RUMM2030 [Citation44] to generate interval level measures of student-environment fit in log odds units (logits). The Rasch model analysis has been described in detail elsewhere [Citation45,Citation46]. In the Rasch analysis, disordered thresholds of items were identified, implying that the scoring of specific items was not functioning as expected. As recommended [Citation46], in the SSI items with disordered thresholds, involved scoring categories were collapsed and ordered sequentially to produce a functioning scale. Rasch-based statistics, i.e. indicators of the fit of the observed data to the mathematical expectations of the model (model fit x2 = 210.29; df = 144; p ≤ 0.001, mean item fit = –0.18, SD = 1.18 and mean person fit = –0.29, SD = 1.02), showed that the SSI data was reliable, valid and unidimensional at both baseline and follow-up. Second, students’ individual change in student-environment fit between assessment time points was calculated. The change in student-environment fit on an individual level was examined by calculating whether the students’ follow-up measure fell outside the 95% confidence interval of their baseline measure, as recommended by Hobart, Cano and Thompson [Citation47]. The individual change was calculated as the student’s follow-up measure minus the baseline measure, which was divided by the standard error of the change. The students’ ‘significance of change’ was categorized into five groups according to the size and direction of the change in student-environment fit: Significant improvement = ≥ +1.96; Non-significant improvement = 0 < Sig. change ≤ + 1.95; No change = Sig. change = 0; Non-significant worsening = −1.95 ≤ Sig. change <0 and Significant worsening = Sig. change = ≤–1.96 [Citation47]. Third, after categorizing students into groups of ‘significance of change’, group differences in student characteristics and outcome measures were investigated between students with Significant improvement of student-environment fit, i.e. students who benefitted the most from the ICT intervention, and the rest of the students using chi-squared tests and a t-test.
Results
Participants
The students mean age was 17.7 years, 57% were boys and 51% had no diagnosis. The majority (70%) were attending a vocational programme and more than two-thirds had some special educational support at inclusion. Almost 30% stated that they used ICTs, such as computers, in their school activities at baseline, see . Among the 187 students for whom grades were collected, 54% (n = 101) passed grades in the core subjects English, Mathematics and Swedish. No differences in student characteristics were found between the present sample (n = 300) and the dropouts from the 549 students that gave consent to research.
Table 2. Participant characteristics of the students at baseline N = 300.
ICT intervention
Thirty-two percent of the students (n = 95) had their existing ICT, such as a computer, tailored to cater for their needs, and 66% (n = 197) had received some sort of ICT device, namely a laptop, tablet and/or smartphone, see . The most common software was directed towards students’ difficulties in planning and structure, with 85% (n = 255) of students receiving calendars, schedules and/or reminders for time assistance. Writing and reading software or aids were received by 75% (n = 225) of the students, with word processor programmes being the most common (55%, n = 166). The median time for the ICT intervention was eight hours. Forty-three percent of the students (n = 128) had received supplementary support in school activities in addition to the ICT, such as extra time with teachers and/or modified examinations.
Table 3. Overview of the ICT intervention, with the two main components of ICT device and software, and complementary services from professionals, implemented in the government projects.
Decrease in perceived need for adjustments in school activities
At baseline, the students’ median number of identified adjustment needs in school activities was six, which had decreased to one adjustment need in school activities at follow-up. The decrease in the number of perceived adjustment needs in school activities was statistically significant, T = 14.54, p = <0.001, with a large effect size, r = 0.59. Among the students, the greatest proportion of perceived need for new adjustments (ratings 1 and 2 combined) at baseline was found in the item Remember things (88%, n = 264), see . This corresponded well with the majority of students receiving ICT to support planning and structure (). As mentioned, the most common ICT for writing and reading was a word processor, used by 166 students (55%). In the school activity Write, the proportion of students who perceived a need for support had decreased from 82% (n = 247) at baseline to 15% (n = 44) after the intervention. The total distribution in the proportion of ratings 1 and 2, indicating perceived need for adjustments, decreased from 39% at baseline to 12% at follow-up, see .
Increased school attendance
Half of the 144 students (51%, n = 74) for whom school attendance was obtained had the same or increased school attendance after the ICT intervention, where 30% (n = 43) of the students had increased their school attendance.
Characteristics of students who benefitted the most from the ICT intervention
Between measurement time points, the majority of students (84%, n = 251) improved their measure of student-environment fit. Twenty-two percent (n = 66) of the students achieved Significant improvement, benefitting the most from the ICT intervention. Worsening of the student-environment fit was noted in 16% (n = 47) of the students, where 1% (n = 4) showed Significant worsening. No change was demonstrated in 0.01% (n = 2) of the students. At baseline, students who benefitted the most, i.e. achieved Significant improvement, had fewer than the median number of perceived adjustment needs in school activities (Mdn = 6), t(298) = 2.4, p = 0.016 and had, to a lower extent, received special educational support in school, x2(1, N = 300) = 5.5, p = 0.02. In addition, students who benefitted the most passed their final grades in the core subjects more often, x2(1, N = 187) = 8.4, p = 0.004.
Discussion
The aim of the present study was to evaluate the impact of an ICT intervention on school participation among upper secondary school students with SEN, and the findings indicated that the ICT intervention, including complementary services from professionals, was promising. On a group level, students in the present study perceived statistically significantly fewer adjustment needs in school activities at follow-up. This finding was confirmed on the individual student level, where the majority of the students (84%) had improved their student-environment fit. Together, these findings reflect improved school participation as proposed by Imms et al. [Citation26], including better prerequisites for attendance and involvement since students perceived an increased agreement between their abilities and the demands of school activities after the ICT intervention. The interventions approach aligns with scholars’ recommendations about tailoring the ICT to the specific needs of the student in order to be successful in accommodating students’ needs in school activities [Citation20–22]. The interventions need-based approach and use of professional knowledge about person-environment adjustments could be considered successful, which would suggest that occupational therapy may provide a valuable complement to other forms of professional competence in student health units to support students’ participation in school activities.
The characteristics of students who benefitted the most from the ICT intervention, i.e. students with Significant improvement in student-environment fit, should potentially be given special attention when considering implementing ICT as support in school activities. These students perceived fewer adjustment needs and were less frequently supported in school activities. Furthermore, they achieved pass grades to a higher extent. Thus, an ICT intervention to improve school participation could be best suited for students whose difficulties in school activities are not enough to merit, or are met by traditional special educational support, such as support from a teacher assistant. As an example, ICT can be a suitable adjustment to support students with difficulties in time management and planning of schoolwork [Citation48], denoted in the school activity Remember things, where 88% of the students perceived a need for support at baseline. At follow-up, the proportion of students who perceived a need for support in that school activity had decreased to 24%.
That almost one-third of the students had increased their school attendance at follow-up and 21% had the same school attendance was considered positive, as truancy and non-attendance increase throughout upper secondary school and have been reported as being more prevalent among students on vocational programmes, both in Sweden and globally [Citation49,Citation50]. The more balanced match between the student and the demands of school activities could have increased students’ sense of competence and self-esteem, motivating them to attend school [Citation51]. As an example, having the opportunity to use a computer for writing could enable equal conditions for involvement in school activities, which might motivate a student with dyslexia to attend. Barriers to participation, such as unsupported needs in school activities, have been found to influence students’ non-attendance [Citation5] and their odds for achieving pass grades deteriorate when they are absent [Citation52]. Thus, new approaches to adequately support students in school activities, such as by using ICT and occupational therapy competence, are not only beneficial to the individual student but also to society at large as increased class attendance reduces failure rates [Citation52]. In Sweden, around 70% of students graduated after three years of upper secondary school, i.e. they passed the core subjects, in 2016 [Citation53]. In comparison, the results of this study revealed a poorer graduation rate than the national average, as just over 50% of the students achieved pass grades. However, the students in the present study all experienced SEN, which, in a recent international review, was found to be negatively associated with graduation from upper secondary school [Citation6]. Nevertheless, if students with SEN graduate, their odds of finding employment increase [Citation54] and their chances of success in further education are as good as any [Citation55], which emphasizes the importance of supporting students with SEN in school activities. This study indicated that an ICT intervention with complementary services from professionals could increase school attendance for upper secondary school students with SEN, which could positively influence their chances of achieving pass grades and graduation, associated with better prospects in terms of employment and further studies after completing upper secondary school [Citation8]. It would therefore be interesting to follow these students after they finish upper secondary school in order to investigate what they do and how they perceive their participation in their current occupation.
It is also worth noting that around 30% of the students in the present study used some sort of ICT in their school situation at baseline but perceived an additional need for support in school activities. This might indicate what several studies have suggested [Citation21,Citation22,Citation56–58], that the ICT must be supplemented with services to be successfully integrated as support in activities, which in the present study was ensured by the services from professionals, primarily occupational therapists, and the use of the SSI [Citation34]. Yet some students (n = 49) showed no improvement in student-environment fit. As all students have the right to develop their full potential [Citation3], these students would probably benefit from a more comprehensive intervention, e.g. including different types of adjustments, psychosocial support and/or additional professional knowledge.
Limitations
Since the ICT intervention may be considered as complex with several potential interacting components [Citation37], the one-group pretest-posttest design, which provides limited evidence of the ICT interventions’ effect on participation in upper secondary school is a limitation of the present study. Yet the large effect size and the individual categorization of significant change in student-environment fit indicate the clinical relevance of the intervention. The findings are promising and worthy of further investigation in studies with vigorous designs. Considering that the outcome measures of participation effectively require tapping into both the attendance and involvement aspects of participation [Citation26], using the SSI [Citation34], study-specific questionnaires, grades and school attendance generated measures that addressed both the students’ perceived participation in education as well as observable aspects. Unfortunately, grades and school attendance were not available for all students, which decreased the representativeness of the population and weakened the validity of the statistical conclusion. However, measures were taken to address drop out by sending reminders and maintaining an active dialogue regarding potential approaches to collecting the required data. Another limitation is the lack of blinding in the intervention process. This could have caused an overestimation of the magnitude of the intervention effects [Citation59]. An attempt was made to take this into account by ensuring that the scale measured the student-environment fit in the same way at both baseline and follow-up. Thus, the Rasch analysis ensured reliable and stable individual measures across the measurement time points.
Implications for occupational therapy practice
The results of this study indicate that an individualized ICT intervention, including services from occupational therapists, can improve the prerequisites for attendance and involvement in school activities and increase school participation among upper secondary school students with SEN. Furthermore, the ICT intervention was most beneficial in improving participation among students who had received no prior support in school, indicating that not all students who perceive adjustment needs in school activities are identified. With the use of the SSI [Citation34], assessing the interaction between the student and the environment in school activities, and professional knowledge from occupational therapists students’ perceived need for adjustments in school activities can be identified and supported adequately. Thus, occupational therapists could be well suited to participating in a student health unit, which is true in some countries but not the case in Sweden where this study was conducted.
Conclusion
The present study indicates that an ICT intervention, including complementary services from professionals, is promising for improving school participation among upper secondary school students with SEN.
Acknowledgements
This study was financially supported by the Faculty of Medicine and Health Sciences at Linköping University, Sweden. The authors would like to thank the SIAT for the provided data.
Disclosure statement
No potential conflict of interest was reported by the author(s).
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