Occupational Therapy in Schools

Hey readers! This semester I took an elective called School-Based Practice in Occupational Therapy. I have a level 2 fieldwork placement at a school this fall, and in general I wanted to learn more about pediatrics. Since approximately 20% of occupational therapists work in schools, I thought this would be a very valuable course to take. You can read more statistics about where OTs work from AOTA here. AOTA also has resources about what OTs do in schools, which you can check out here.

My greatest takeaway from this course is that all OT interventions in a school must be educationally relevant. All student goals must relate back to their ability to access and participate in the school curriculum, in all environments. This can include the classroom, cafeteria, playground, school bus, hallway, bathroom, gym, etc. Furthermore, all goals should be able to be tracked by multiple school personnel (e.g. teachers), not just the OT. This means that you may not necessarily write “OT goals”, but rather you would write “student goals” that anyone can help the student achieve.

Another takeaway from this course is the movement from “pull-out” services to “push-in” services. This means that OTs must provide services in the least restrictive environment (i.e. the classroom) rather than taking the student out of the classroom and going to a separate therapy room.

OTs also must be familiar with the state and national laws and regulations that dictate school OT services. According to the IEP, OT is a “related service” that helps a child access general or special education or the 504 plan. There are lots of laws to be aware of!

There are three tiers to school-based OT intervention, here are the definitions and examples of each:

Tier 1

Tier 1 services are provided to the entire school and/or school district. This may be a school-wide bullying initiative led by the OT, or it may be a training that the OT provides to all of the teachers to support all students, regardless of individual need for OT services. This type of intervention is often preferred because it benefits all students.

One example is a school-wide handwriting screening using a screening tool and assessing desks, chairs, and positioning for handwriting. An OT may also educate teachers about self-regulation using the Zones of Regulation, and the entire school may adopt this regulation strategy.

Tier 2

Tier 2 is more intensive, specialized instruction that focuses on specific skill areas. This may occur in a small group setting, for example in a social skills group. The OT may use strategies such as Social Thinking to promote social emotional learning. The OT may also do this with handwriting or other skills.

In order provide small group instruction in the least restrictive environment, the OT may work with the teacher to determine a time when the class will be working in groups and the OT is welcome to come in. At that time, the OT would work with the student(s) who require small group instruction, along with a few peers who may act as examples of the desired behavior/skill. This will allow the OT to provide specific strategies and instruction to the students who need it without taking them out of the classroom and disrupting their curriculum.

Tier 3

Tier 3 is individualized intervention. This would be used after the less restrictive tier 1 and tier 2 supports have been attempted. If the student is not making progress with those supports, then the OT would provide tier 3 services. This may include modifications or accommodations of school routines, environmental modifications, assistive devices/technology, individualized instruction, sensory supports, and more.

One example that can be used during tier 3 intervention is the Cognitive Orientation to Daily Occupational Performance (CO-OP) approach. The CO-OP approach was developed for students with developmental coordination disorder, but has since been used successfully with children with other diagnoses. The CO-OP approach can be used in a tier 3 intervention to support handwriting because it is goal-oriented and allows the student to develop their own strategies through guided self-discovery.

I used the CO-OP approach every session with my client this semester, and I found it to be very successful!

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