Supporting children with disabilities at school: implications for the advocate role in professional practice and education.
OBJECTIVE
School settings are a common practice context for rehabilitation professionals; health advocacy is a common and challenging practice role for professionals in this context. This study explored how pediatric practitioners advocate for children with disabilities at school. Specifically, we examined everyday advocacy in the context of school-based support for children with disabilities.


METHODS
Our theoretical framework and methodological approach were informed by institutional ethnography, which maps and makes visible hidden social coordinators of work processes with a view to improving processes and outcomes. We included families, educators, and health/rehabilitation practitioners from Ontario. Of the 37 consented informants, 27 were interviewed and 15 observed. Documents and texts were collected from the micro-level (e.g. clinician reports) and the macro-level (e.g. policies).


RESULTS
Pediatric practitioners' advocacy work included two main work processes: spotlighting invisible disabilities and orienteering the special education terrain. Practitioners advocated indirectly, by proxy, with common proxies being documents and parents. Unintended consequences of advocacy by proxy included conflict and inefficiency, which were often unknown to the practitioner.


CONCLUSIONS
The findings of this study provide practice-based knowledge about advocacy for children with disabilities, which may be used to inform further development of competency frameworks and continuing education for pediatric practitioners. The findings also show how everyday practices are influenced by policies and social discourses and how rehabilitation professionals may enact change. Implications for Rehabilitation Rehabilitation professionals frequently perform advocacy work. They may find it beneficial to perform advocacy work that is informed by overarching professional and ethical guidelines, and a nuanced understanding of local processes and structures. Competency frameworks and education for pediatric rehabilitation professionals may be improved by: encouraging professionals to consider how their practices, including their written documents, may affect parental burden, (mis)interpretation by document recipients, and potential unintended consequences. Policies and texts, e.g. privacy legislation and the Diagnostic and Statistical Manual (DSM), influence rehabilitation professionals' actions and interactions when supporting children with disabilities at school. An awareness of the influence of policies and texts may enable practitioners to work more effectively within current systems when supporting individuals with disabilities.
a Centre for Faculty Development, St. Michael's Hospital , Toronto , Canada .|b Centre for Ambulatory Care Education, Women's College Hospital , Toronto , Canada .|c Department of Speech-Language Pathology , University of Toronto , Toronto , Canada .
Stella L
SL
Ng
d Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University , London , Canada .|e Department of Medicine , Schulich School of Medicine & Dentistry, Western University , London , Canada .
Lorelei
L
Lingard
d Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University , London , Canada .|f Faculty of Education , Western University , London , Canada .
Kathryn
K
Hibbert
g Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University , London , Canada .
Sandra
S
Regan
h Department of Occupational Therapy, Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Canada .
Shanon
S
Phelan
f Faculty of Education , Western University , London , Canada .
Rosamund
R
Stooke
d Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University , London , Canada .|i Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University , London , Canada .
Christine
C
Meston
j Department of Professional Communication , Ryerson University , Toronto , Canada , and.
Catherine
C
Schryer
k Autism and Behavioural Sciences, George Brown College , Toronto , Canada.
Madhushani
M
Manamperi
a Centre for Faculty Development, St. Michael's Hospital , Toronto , Canada .
Farah
F
Friesen
D002648:Child; D019988:Children with Disabilities / Q000534:rehabilitation*; D004519:Education, Special / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D009864:Ontario; D010290:Parents / Q000523:psychology*; D010372:Pediatrics; D011364:Professional Practice / Q000458:organization & administration*; D012574:Schools / Q000458:organization & administration*; D012944:Social Support
Advocacy; competency-based education; disability; health services; pediatrics; special education