Back-to-school advice from an OT practice owner to fellow therapists

Keeping focused during back to school 

Advice for OTs

In my private pediatric occupational therapy practice, back to school time means changes in schedules and fluctuations in treatment hours. It means new concerns to be dealt with, new needs to be addressed and much more confusion and uncertainty all around.

Keeping my practice running smoothly during this time while addressing the many needs of my clients and their families requires a certain focus.

To understand better what goes on in a typical pediatric clinic at back to school time, here is a list of the most frequent questions or statements that I field: 

From Parents:

  • My child is going to start receiving therapy at their pre-school now, so they said you won't need to see them anymore.
  • Why is the school not providing therapy for my child now when he has been receiving therapy up to this point from you?
  • Can you come to the IEP meeting with us?
  • I will just make the school treat my child for OT. That will be easier for everyone.
  • Can you treat my child for therapy after school?
  • Little Johnny is not doing too well in school when it comes to paying attention and following directions.
  • But the teacher said to do it this way.
  • I’m not happy about the amount of therapy they give my child at school.
  • They want to medicate my child because he won’t sit still
  • How late do you provide therapy?
  • How do I arrange therapy around ball practice?   

 From Therapists:

  • I keep losing kids to the county Co-op.
  • I can't keep up with these new evaluations.
  • My schedule is a wreck.
  • I can't fit these new kids in my schedule.
  • Do you know where the BOT is?
  • I'm going to need the Spanish interpreter for this evaluation.
  • I don't think the school liked me showing up for that child's IEP, but mom asked me to go.
  • These are just a few conversations that happen during the transition of back to school in the fall.

Parents are under a lot of stress sending their child to school, especially if this is their child's first time going there.  If you add the fact that the child needs therapy, and possibly several different disciplines, both parent and child may feel overwhelmed.

Therapists are also under pressure to accommodate client schedules and perform the many new evaluations which private practice can receive this time of year. 

Recently we had a couple of parents whose children were going to attend the local Head Start pre-school. The parents asked if we could treat their child there. I explained that in the past the local Head Start did not allow us to treat in their facility. I let these parents know that if they could get clearance for us to treat at the pre-school, we would be happy to do so.

The parents spoke to the pre-school and received permission for us to treat there, so I called the pre-school to confirm this. After my therapists began treatment, I received a phone call from the local Co-op (not the pre-school). I was told that we could not treat the clients at the pre-school because they, the Co-op, had an "inter-agency agreement" with the pre-school which meant only they could treat children there. 

These are two separate agencies, the Co-op and the Head Start, and my clinic has a contract to provide services for the Co-op. On top of that, these kids had only received therapy through my practice. We were not "stealing" clients from anyone. But rules are rules, and unfortunately, I cannot change such mammoth bureaucracy.  

I informed the parents of the situation. I let them know that we could continue to treat their children but we now had to refer their child to the Co-op.  Then the Co-op would have to evaluate their child and develop an IEP. At that point, they could refer the child back to us for treatment in the pre-school.  To top it off, this could take up to 45 days!  Bureaucracy is often the biggest trouble maker.

As you can imagine, these parents were not pleased. My therapists were the only therapists their child had ever had. These parents knew and trusted us because a relationship had been formed that was based on care and concern and developmental milestones were being reached. They didn't understand why this was not recognized by the pre-school. During this major transition for their child, they wanted the comfort of knowing they would have a consistent therapist that they could trust. 

As you know, providing therapy for any client is a personal encounter. We are not stuffing envelopes or hitting nails into a wall. We are providing a service which involves creating relationships with our clients and their caregivers. 

As our private practices make the transition to the back to school season, we have to keep this specifically in mind. Private practice is a free market healthcare system. It is healthcare as it should be with both competition guided by the consumer and service oriented to the individual.

People do business with other people that they know, like and trust. The important thing to remember is that we have a calling as therapists:  to treat the individual person with skill and care and to provide a service that will make their life happier and more fulfilling. If we lose focus on this, then therapy becomes more like the Department of Motor Vehicles. Take a number, shut up and sit down. And you better have your paperwork right or you are out of here. Who wants that?

As a small business owner, I am constantly thinking of new and improved ways to market my private practice. How do I get the word out and attract new clients? There is only one right way to market any small helpful. How can I help both my current and prospective clients?

Good marketing is a by-product of being helpful. If you are helpful enough, you will elicit an effective response from the person who receives your help.  You won’t be forgotten, and your reputation will only spread.

Remember, the business or service you provide is not all about you and your needs. It is about the benefit you can provide to someone else which will enrich their life. This is an important distinction. If your only goal each turn of the season, whether it be back to school or summer vacation time, is to make more money, then you are forgetting what the heart of your profession embodies. 

As we enter the back to school season, let’s remember that as therapists our ultimate goal should be to enrich the lives of our clients and make the world a better place one person at a time.

Scott Harmon is an Occupational Therapist who has owned and operated two pediatric therapy clinics since 2006. Scott and his wife Jennifer, who is also an OT, have 6 kids. You can check out his clinic website at and his consulting website at