Occupational Therapy in Schools (Guide + Directory)

Occupational therapy (OT) helps people participate in their daily activities, when a health condition or disability makes it difficult to do so. 

For school-based OTs this means helping a child participate in their schooling, when there are barriers to doing so. 

You may have found this article because your child was referred to school-based OT. Or you may be an aspiring school OT yourself, either way we will answer your basic questions about school OT. 

Here’s what we’ll cover:

Your child’s right to evaluation if they have a disability

In the United States, school districts must provide a free appropriate public education (FAPE) to children with disabilities. 

This means that schools must identify and evaluate students who may have disabilities, at no cost to families (This covers children from birth to 21.) As the parent or caregiver, you have the right to request an evaluation if you have concerns. 

You can read about this federal policy called IDEA here. Child Find is a resource that walks you through reaching out to your school to schedule an evaluation. 

 

Other important mandates to know related school OT for your child

We already mentioned the right to evaluation that is mandated under IDEA. But, there’s a couple more mandates we should review to fully understand school-based OT. 

If your child does qualify for services, IDEA gives them the right to 3 basic things related to OT: 

#1 An Individualized Education Plan

The individualized education plan (IEP) is a written document, which lays out a plan to meet a student’s unique educational needs. The IEP is developed by an IEP team (which may include an OT). 

#2 Education in the Least Restrictive Environment

Education should take place in the Least Restrictive Environment (LRE) possible. This means that children should not be pulled unnecessarily out of the general education classroom. 

#3  Parent Participation

Parents or caregivers have the right to equal participation in this process. They are entitled to: 

  • Requesting an evaluation 
  • Notification of a planned evaluation
  • Access to planning and evaluation materials
  • Involvement in all meetings regarding their child’s placement and services 
 

Occupational Therapy’s Role in Schools

Now that we know the basic mandates that guide our practice, we can look at the specific role of OTs in helping individual students. 

According to IDEA Occupational Therapy includes

  • Improving, developing, or restoring functions impaired or lost through illness, injury, or deprivation
  • Improving ability to perform tasks for independent functioning if functions are impaired or lost
  • Preventing, through early intervention, initial or further impairment or loss of function.

That language sounds very general, so let’s look at the specifics of evaluation and treatment: 

 

What does an OT evaluation and an IEP entail?

When a concern is raised, your occupational therapist will evaluate your child for any area of concern related to OT. 

This blog post walks through the many steps of a school-based OT evaluation. 

Here is a list of the standardized assessments we may use (which gives you an idea of a the specific areas we may look at related to your child’s ability to participate in school.) 

  • Assessment of Life Habits
  • Beery-Buktenica Developmental Test of Visual-Motor Integration
  • Behavior Rating Inventory of Executive Function
  • Bruininks-Oseretsky Test of Motor Proficiency
  • Canadian Occupational Performance Measure
  • Child Occupational Self Assessment
  • Children’s Depression Inventory
  • DeCoste Writing Protocol 
  • Developmental Assessment of Young Children
  • Developmental Coordination Disorder – Questionnaire
  • Developmental Test of Visual Perception
  • Evaluation Tool of Children’s Handwriting
  • Goal-Oriented Assessment of Lifeskills
  • Little Developmental Coordination Disorder Questionnaire
  • MacArthur-Bates Communicative Development Inventories
  • McMaster Handwriting Assessment Protocol
  • Miller Function and Participation Scales
  • Mullen Scales of Early Learning
  • Peabody Developmental Motor Scales
  • Pediatric Specific Quality of Life Questionnaire
  • Perceived Efficacy and Goal Setting System
  • Preschool Language Scale
  • Roll Evaluation of Activities of Life
  • School Function Assessment
  • Self Perception Profile for Children
  • Sensory Processing Measure
  • Sensory Profile™ 2
  • The Short Child Occupational Profile
  • Social Communication Questionnaire
  • Social Responsiveness Scale
  • Test of Gross Motor Development
  • Test of Visual Perceptual Skill 
  • Wide Range Assessment of Visual Motor Abilities

After our evaluation, goals are crafted for the IEP ideally in close collaboration with the student and parents. As with any pediatric OT interventions, the treatment is most successful when it is guided by child-set goals. These goals are reviewed at least once a year, but can be reviewed more frequently if needed. 

Here’s a helpful blog post about the transition from OT-driven goals to child-led goals. 

 

What does OT treatment entail?

Often, OT treatment involves a focus on the actual activity that is in the child’s goal area. 

We call this a “top-down approach” (versus a bottom up approach that focuses on specific body structure and skills.) We take this approach because it has the most robust support in evidence

Here the qualities of a top down approach: 

  1. Begin with the child’s goal.
  2. Practice real-life activities in natural environments.
  3. Use intense repetitions to activate neuroplasticity.
  4. Use scaffolding to find the “just right challenge.”

Here is a blog post summarizing the evidence behind some of the most common pediatric interventions. (Not all of them can be done in school, but it will give you a sense of the scope of OT.)

In addition to this general top-down approach, your OT will also take into account evidence based treatment for your child’s specific condition. For example, here is an overview of OT for cerebral palsy.

 

How do OTs support the entire student body?

While the majority of OTs work individually with students via one-on-one sessions, OTs in the U.S. are also uniquely suited to provide services to the entire student body, including students in the general and special education classrooms. 

Recent legislation called the Every Student Succeeds Act (ESSA) is an important piece of legislation when considering OTs role from a population or group-level. One of the primary purposes of ESSA is to encourage districts to support all students via early intervening and prevention approaches. ESSA names multi-tiered services, which includes Response to Intervention, as one way to accomplish this. 

ESSA explicitly names OTs as Specialized Instructional Support Personnel (SISPs) and argues that SISPs are well-suited to provide multi-tiered services to all students. 

Here’s a nice handout on OTs role in supporting the student body through ESSA. 

 

How does a school OT spend their time?

As you can tell, OT professionals wear many hats in the school-based setting. 

To meet the needs of our students, teachers, and other staff, our work week can be busy! Here is a list of responsibilities school-based OTs have each week per this article.

  • Scheduling students for treatments, consultations, etc. 
  • Daily documentation 
  • Direct student intervention or one-on-one sessions 
  • Staff consultation and education
  • Family or caregiver consultation and education
  • Conducting evaluations, re-evaluations and screenings 
  • Report writing (e.g., evaluations, screenings, etc.) 
  • Team meetings
  • Student observations
  • Travel time between schools 
  • Professional Development
  • Material development and treatment planning 
  • Medicaid paperwork
  • Behavioral support (e.g., helping a student get on/off the bus each day)
  • Committee and/or Special Education meetings
  • Participation in events (e.g., back-to-school night)
  • Outside provider consult
  • Multi-tiered systems of support or Response to Intervention 
  • Advocacy
  • Research
  • Participation in school committees
  • Grant writing

Trends in school-based OT

I would be remiss not to mention two important trends in school-OT. 

  1. Moving away from compliance-based interventions. 

Compliance-based treatments involve rewarding children for certain behaviors and punishing others. While this can produce short term results, there can be damage long-term. Pediatric OTs are part of a larger movement coming to terms with the potential harm of this approach. New behavioral strategies are becoming more common, such as redirection. 

  1. Leveraging our training in mental health

OTs are unique among rehab professionals because of our focus on mental health in our schooling and scope of practice. There is a movement among OTs to utilize this dimension of our schools set to support the student body. See the website, Every Moment Counts, to see some occupational therapy-led initiatives. 

 

Resources for school-based OTs

Phew! We’ve covered lots of the essentials about school OT, but there is lots more to learn! So we are going to leave you with some resources for further reading: 

Statements by the AOTA on school-based OT:

Brochures and Resources from the AOTA:

The emerging research behind multi-tiered systems of support

Websites by and for school-based OTs: 

 

Find a school-based OT near you

Sometimes it helps to actually connect with a school based OT. You can use the OT Near Me Directory to find a school-based OT in your area. 

Conclusion

It is an honor for us as occupational therapists to serve students in a school-based setting. As OTs, it is our purpose and passion to meet our students exactly where they are — and we know our treatments are most effective when they can be delivered where people spend their time. So, it is meaningful for us to be working in a setting where kids spend so much of their time. 

We also know that helping children succeed can take a village. Working in the schools gives us the awesome opportunity to partner with families, teachers, and other professionals who are invested in helping each and every child succeed. 


See our OT Potential Podcast courses!

  • Virtual Reality and OT with Christopher Gaskins
  • Trends in Rheumatic and Musculoskeletal OT with Winnie Tsui
  • OT for Hand Burns with Jody Sabel
  • Lifestyle Medicine and OT with Ryan Osal
  • CIMT and OT with Catherine Hoyt
  • School-based OT Workload Trends with Jayson Davies

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