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Occupational Therapy + Schools = A Winning Equation!

New to school-based occupational therapy (OT)?

Are you a new grad and just received a position as an OT/OTA in the schools?

Or perhaps you are curious what school-based OT looks like.

Whatever your interest, this will be your pediatric primer for everything you need to know about occupational therapy in the schools...

Let’s Start with the Basics: What is School-Based Occupational Therapy?
In a school-based model, OT services can only address deficit areas that can be related back to the student’s education. The purpose of school-based OT is to help a child benefit from their educational program. This means that school-based OT must address deficits that have an educational impact.

School-based occupational therapy can be provided for students aged 5-21. These services are primarily provided to students through an Individualized Education Plan (IEP), 504 Plan, or through Response to Intervention (RTI) services.

What is a Related Service?
The Individuals with Disabilities Education Act (IDEA) is an educational law that makes available a free appropriate public education to eligible children with disabilities and ensures related services to those children.

Related services is the term for those services a child needs in order to benefit from special education. Related services help children with disabilities benefit from their special education by providing extra help and support in needed areas.

Occupational therapy is one of the identified related services.

One easy way of remembering this, is that related services are supports that a student needs that are related to their learning and their ability to participate in everyday school-wide routines and activities.


Similarities + Differences: Does School-Based OT Differ from Outpatient or Clinic OT?
While school-based OT works on goals related to the student’s school performance, outpatient OT goals are focused on the child’s home and community function, as opposed to their function at school. In the clinical setting, therapists may also interact with the child’s primary caregiver and siblings to address issues at home. In the school setting, therapists interact primarily with the student’s teachers and support staff to address classroom, learning, and school related issues (although parents continue to be a vital and important role in their child’s overall support team).

School-based occupational therapists observe, assess, and address the child’s strengths and needs within the natural school settings, such as the classroom, lunchroom, or playground in order to support the student’s educational program. Services may be directed to the child and on behalf of the child in the school environment, such as training educational staff.

To sum it up:

  • School-based OT uses an educational model that focuses on education and academic performance and is governed by IDEA (Individuals with Disabilities Education Act).
  • Clinic-based OT follows the medical model that focuses on working with a medical diagnosis and is prescribed by a doctor and often directed by insurance.


Q: Is school-based OT only meant to address academic concerns?
A: No! School-based OT can address any area related to a student’s overall educational program.

It is important to remember that school isn’t just about reading, writing, and math. In the classroom students also need to do things like keep their work organized, pay attention during class, sit safely in their seat, and be able to use school tools such as pencils, scissors, and math manipulatives.

Outside of the classroom, students need to feed themselves and manage the cafeteria, transition safely and appropriately in the hallways, use the bathroom independently, and play appropriately with peers on the playground.

Basically, if there is any task that falls into the scope of OT in general, and it is impacting the student’s access to their education, school-based OT may address it.

Q: What are specific examples of areas that school-based OT can work on?
A: School-based OT can focus on academics, play and leisure, social participation, self-care skills (ADLs, or Activities of Daily Living), and transition/work skills. They depend on the individual needs and age of the student and overall support academics, behavior, and functional performance.

Here is a list from the American Occupational Therapy Association (AOTA) that describes some of the many ways school-based OT can help students:

  • Adapting activities and environments so students can participate.
    • For example, modifying playground equipment; recommending bus or classroom seating; recommending lunch groups in cafeteria for social participation; offering strategies to increase participation in activities such as gym and chorus
  • Addressing sensory, cognitive, or motor needs that impact access or participation in the curriculum.
    • For example, increasing coordination so the student can manipulate a backpack, or assessing tolerance for fire drill noise for those with sound sensitivity
  • Collaborating with school personnel to provide education on disabilities or use of a sensory plan
  • Increasing independence in daily living skills
    • For example, addressing self-care such as toileting or organizational skills needed for homework completion
  • Promoting positive behavior and interaction that impacts learning
    • For example, sharing, turn-taking, social skills training
  • Recommending assistive technology to increase learning access and participation
    • For example, recommending computer software, pencil grips, modified seating
  • Supporting school mental health
    • For example, offering anti-bullying initiatives and promoting coping and calming skills for social participation
  • Increasing attention
    • For example, by recommending motor breaks and alerting activities
  • Supporting transition toward employment, community integration, and further education
    • For example, increasing student ability to perform the activities associated with an after school job or internship

Q: What might a typical school-based OT session look like?
A: School-based OT sessions can be done in two ways:

  1. Push-in Services: Students are seen in their classroom, engaged in their natural occupation of learning. 

  2. Pull-out Services: Students leave the classroom and are typically seen in a therapy space, where their IEP goals will be addressed. 

Let’s go into more detail on how push-in and pull-out therapy services can be combined for success…


Emily receives OT services twice a week, once in the classroom and once in the therapy room. She has an IEP goal to work on writing skills, so the therapist will be helping with the foundational skills Emily will need to be successful, as well as any strategies that may be helpful for Emily to engage in her classroom task.

Emily’s OT joins Emily as a push-in session in her classroom for her first weekly session during ELA time. The class is working on a writing assignment. The therapist notices that Emily is gripping her pencil very tightly and has all of her fingers wrapped around the pencil and that it is taking Emily longer than her peers to write, as she keeps shaking out her hands and says they feel tired. Her therapist provides a special pencil that is very short and makes a dot on the pencil as a visual cue for where Emily’s thumb should go, which allows Emily to see where to place her fingers on the pencil and she can write longer without fatiguing. Her therapist makes a note to work on hand strengthening during Emily’s next pull-out session and to provide the teacher with a list of simple activities that can be incorporated throughout Emily’s school days that will help increase her hand strength so that she can write longer and more neatly. Her therapist notices that Emily is getting frustrated because she is having difficulty scanning her textbook for finding the vocabulary words she needs to write. Her therapist first pulls out a small picture with a large square on it and encourages Emily to trace the outline of the square, repeating breathing in on one side and out on the other side. After a few deep breaths Emily feels more calm and focused and is ready to get back to writing. Her therapist uses a blank piece of paper to cover up and minimize the area Emily has to look at and she places a small sticky note on the top left of the paper to remind Emily to begin looking from top to bottom and left to right to scan for her vocabulary words on the page. Emily finds the words she needs and write them on the special lined paper her therapist has brought for her and she completes her assignment at the same time as her classmates.

Later that week, Emily receives her second weekly OT session in the therapy room as a pull-out session. She brings her list of spelling words with her to work on during the session. First, Emily’s therapist gives Emily a few movement activities and animal yoga poses to complete, to work on her trunk and upper body strength and to help her nervous system be alert and ready to focus. Then the therapist has Emily cut out her spelling words and places a clothespin on each word and then places them on a long piece of string. Emily takes turns using her hands to pinch open the clothespins and then writes each spelling word on the large chalkboard, reviewing how each letter is formed using words such as down/ across/ top/ bottom/ over/ under, etc. Emily does a great job writing all of her spelling words on the board and is then able to play a fun game using tweezers to sort small ocean animals (Emily loves the ocean and wants to be a dolphin trainer when she grows up). Emily and her therapist walk back to the classroom, playing I Spy in the hallway, looking for letters on the walls that are in Emily’s name.


School-based OT is not only important for student’s learning, but it is fun, too!

Therapy works on the student’s goals and individual needs, but it can be done through the student’s interests and through a variety of creative activities, such as movement, crafts, games, music, and more!

Hopefully this glimpse into school-based OT has you excited to walk through those front doors of your school and helps you to see:

From classroom to lunchroom or pencils to clothespins, 
school-based OTs work to help kids be the best students they can be!

How Do I Know if My Child May Benefit from OT?

Author: Lisa Smith, OTR/L
I started off in college in Education, but after a semester I realized that I also felt a strong pull toward the health fields and found that occupational therapy was a perfect combination of both. I like that OT is hands-on, allows you to use your creativity, challenges your problem solving skills, and is never the same day-to-day. Plus it is fun! I enjoyed working with preschoolers and now I am enjoying the challenge of working with middle school and high school students. They keep me on my toes and make me laugh every day.

Tags: occupational therapy, School-Based Therapy, Pediatrics