School Based Occupational Therapy

man happily chasing his daughter outside

The American Occupational Therapy Association (AOTA) defines school-based occupational therapy as supporting students’ “academic achievement and social participation by promoting occupation within all school routines, including recess, classroom, and cafeteria time.”

School-based occupational therapists help children fulfill their role as students, preparing them for college and careers, as well as community involvement.

We spoke with Lou Ann Hintz, Ph.D, Assistant Professor of Occupational Therapy in the TTUHSC School of Health Professions, about the array of services provided by school-based occupational therapy and why it’s such a rewarding career option.

What Services are Provided in School-Based OT?

Hintz explains that the services provided are based on the student’s individual educational needs. This support may take the form of partnering with speech and physical therapy which are called related services because they are related to the student’s educational needs. Partnering with other professionals to help with social skills is an important component in helping the student.

“When we talk about occupational therapy and physical therapy as related services, activities that school-based occupational therapists address tend to include improving gross and fine motor skills,” says Hintz.

OTs also aid students in accessing technology, especially those with a disability.

“It helps them be successful when we can get them access to technology,” she says. This includes helpful software and computers, adaptive seating and positioning so it’s easier to participate.

Collaboration with classroom teachers is an essential part of the school-based occupational therapist’s job.

“We look at and analyze the context of their classrooms, looking at their environment,” Hintz explains. “How can we change it to enhance and support their participation?”

Students with autism process sensations (light, sound, touch) differently, for instance.

Through the work of a school-based OT, environmental changes to lights, sounds and tactile surfaces can be made.

“Sometimes we find that fluorescent lights are somewhat of a trigger for students with autism,” she says.
Sound adjustments can be made, as well as using noise cancelling headphones.

All of these changes are about increasing the level of participation for students with special needs.

How Do Students Qualify for School-Based OT?

“If a student has a disability and is eligible to receive special education services, they automatically qualify for the related service of occupational or physical therapy. However, based upon the individual needs of the student, the educational team makes the decision on whether or not to provide services.” Hintz says.

The educational or Individualized Education Planning (IEP) team will determine the goals and how much support the student might need.

“In school-based practice, we all have to set aside our ego and work as a team. That team includes a school administrator, a general education teacher, a special education teacher, sometimes a speech therapist, and of course the parents,” Hintz explains.

This is the team that will eventually decide about what services are best for the student, which is better than a unilateral decision.

The evaluation process is very different from outpatient occupational therapy. Hintz explains the difference between an educational model and a clinical one:

“In clinical, the evaluation process is bottom up,” she says. “School-based OT is looking at a student from the top down,” a referral coming from a teacher or parent that is functionally related to the student.

For instance, there may be a concern that a student is struggling with language arts or having difficulty with handwritten assignments.

“The OT looks at that student from a top-down approach and looks at how they’re functioning and engaging and participating, then working down and figuring out the underlying issues contributing to the issue the parents and teachers are seeing,” she says.

Interventions are then agreed upon and utilized in the classroom. Hintz points out the benefit of these interventions becoming part of the child’s daily routine. They can have more of an impact on the child because it’s a team-based approach that’s embedded in their daily routine, compared to the clinical model that may be once or twice a week.

The Legality of School Based Occupational Therapy

“Our federal laws have really guided us on how we provide our services,” Hintz says.

There are laws at the federal level that determine how school-based providers deliver their services.

“It stems back to 1972, when the Education for Handicapped Children’s Act first passed in the United States,” she explains.

At that time, more than a million children were being denied access to in-school education. They were either at home, in institutions or just ignored. That law (which was reauthorized in 1990 as the Individuals with Disabilities Education Act, or IDEA) mandated that students receive occupational and physical therapy to support them in their education.

“It was a radical change for them to get to be included in public schools,” she says.

This law transformed the practice of occupational therapy as a profession because of the opportunity to get into schools and impact children face to face. The reauthorization of the law placed more emphasis on children with disabilities to be included with their general education peers as opposed to separate classrooms.

The Every Student Succeeds Act (ESSA) was signed into law in 2015. This identified occupational therapists in schools as “specialized instructional support personnel.” This means that school based occupational therapists are federally mandated to support the academic achievement of all students, not just special education or students with disabilities, but everyone. They now participate in school wide systems of support as well as providing professional training.

“This is exciting news for occupational therapists!” says Hintz.

Hintz is passionate about the positive impact occupational therapists have on all students.

“We have the skill sets to provide services to a broader range of students and cast a broader net and impact the lives of children across school settings.”

This includes providing fine motor activities for kindergarten classrooms as well as training entire groups of teachers for making the environment comfortable and effective for all.

A Career as a School-Based Occupational Therapist

Hintz believes that this is a very exciting time to be a school-based OT or PT.

“We have, through the 2015 ESSA act, the opportunity to demonstrate a skill set and have an impact on a large number of students,” she says. “That’s very exciting and something we’ve never had before in school-based practice.”

The long-term relationship that can be built as a school-based therapist is a striking difference from a clinical one.

“Clinical therapists are limited to who they serve based on third-party reimbursement and insurance providers,” she explains. “With school-based practice, you have the opportunity to follow a child between the ages of 3 and 21. I don’t know of another career that has something like that.”

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