7 Common Mistakes School-Based OTs Make

Whether you’re brand new to school-based occupational therapy or if you’ve been practicing for a while, you are bound to eventually make a mistake or two. This is all part of the learning process, and it’s okay! At the same time, it’s worthwhile to avoid mistakes that can cost you time, money, or even get you in legal hot water. That’s why I’ve collected this list of common mistakes school-based OTs make so you don’t have to!

Not familiarizing yourself with the laws, rules, and regulations

The importance of this can’t be understated. This is easily the biggest difference between school-based practice and other settings, and it’s likely that your pediatrics class in OT school didn’t have time to go over all of the different laws and regulations that can affect school-based practice. Luckily, this information is available freely online. Not being familiar with these laws and regulations can have big consequences, from denying students services they need to engaging in behaviors that put your license at risk. So if you’ve never really read the laws that school-based OT is based on, check out the following documents:

  1. Individuals with Disabilities Education Act (IDEA)
  2. Section 504 of the Rehabilitation Act 
  3. Americans with Disabilities Act
  4. Your state OT regulations/practice act
  5. Your state education regulations
  6. Your district’s special education policies and procedures

Many states may also have a guide specifically for school-based OT, which can be super helpful to break down all of these different regulations.

Not understanding the difference between the medical model and the educational model

This is a mistake I see many therapists who come from outpatient peds making, and it’s definitely an area I didn’t fully understand until I was actually practicing in the schools. The biggest difference between these two models of service is that school-based OTs must address deficits that have an educational impact. This difference is subtle and sometimes challenging to see at first. Put simply, in a medical model, occupational therapy services can address any deficit area for the sake of remediating a deficit (as long as funding sources allow). But in a school model, OT services 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. 

Still confused? To put it another way, school-based OTs attempt to help their kids be the best students they can be. In the medical model, pediatric OTs help their patients be the best tiny humans they can be in ALL of their roles.

To read more about the differences between these settings and models, check out this article that goes much more in-depth.

Only addressing fine motor skills

This is one of the most common mistakes school-based OTs make. Many people, including other school-based OTs, are misinformed about our scope of practice in the schools. School-based OT often gets pigeonholed into only supporting fine motor skills, especially handwriting. Some people even think that this is the only area that school-based OTs should be addressing. But truthfully, this is not supported by any of those laws mentioned above, and our scope of practice is much wider. 

Mistakes School-Based OTs Make

Not completing thorough school-based OT evaluations

This goes hand-in-hand with the last mistake – many school-based OTs only do a standardized test of fine motor skills and consider their evaluation. But truthfully, a good school-based OT evaluation goes much more in-depth than that. Standardized test scores are one part, but they must be related back to educational access, which requires observations in the natural environment, interviews with the student, teacher, and caregiver, and reviewing previous data. Plus, I’m a big proponent that our evaluations should be holistic and look at the whole picture of a student – which means considering other barriers to access besides just fine motor skills. 

Not building relationships and educating your teams

You could say that developing rapport with caregivers is important in any setting, but this is truly the key to being effective in the schools. Since you’re only spending a bit of time with your students, most of your skill lies in training teachers, paraprofessionals, and parents on the strategies you’d like students to use every day. But it’s incredibly challenging to get that carryover with caregivers when they don’t really know you. So spend time right from the start being friendly and getting to know people. Plus, the more you get to know people, the more you can help them understand your role as a school-based OT – which will make your job much easier. There are certainly barriers to this, including that most school-based OTs aren’t assigned to just one building, but it is a worthwhile endeavor. 

One last thing – don’t assume that the only people you should give the time of day are teachers. Custodial staff, office managers, and admin assistants are typically awesome people who can really help you out in a jam. 

Not setting up systems for time management

Schools in America are chronically underfunded, and one way this shows up is intense workloads for school-based OTs. While you shouldn’t be expected to carry a truly unmanageable caseload, there are some time-saving strategies that you can employ. One way I do this is by blocking off my schedule for all of my specific tasks such as treatments, evaluation, documentation, responding to emails, and LUNCH. Reserving space in your schedule for ALLLL of the tasks you end up doing helps prevent more treatment time from being added where it simply won’t fit in. Other ways I save time involve keeping completely digital documentation, attempting to only be in one building per day, and using Google Forms to track consults with teachers. If you’re doing all of this, and you find yourself still struggling to come up for air? Talk to your admin. It’s likely that more staffing is needed. And no matter what you do, never work off the clock or more than your contracted hours. 

Mistakes School-Based OTs Make

Not ensure there is a referral process in place

If you’re joining a team of established school OTs, you might find that there already is a referral process and that it’s working well. If so, score! But as a travel OT who has worked in many districts with inconsistent staffing, I find that this isn’t always the case. Setting up a referral process can help you ensure the students that are referred to you for assessment are appropriate and will likely be recommended for services. I can’t tell you how many students I’ve assessed that didn’t go through a referral process who had no need for school-based OT. And the sad part is, for most of these students I could have told you that after spending 30 minutes with them! For this reason, I try to heavily recommend that students are screened when appropriate instead of heading straight to OT assessment. This will allow me to observe the student in their natural environment and watch for any difficulties that have been reported. I also like this option because it allows me to start giving strategies to teachers right away – whereas the assessment process can take several months before the reports are reviewed and recommendations are implemented. Before you implement this step, check with your district to ensure that they are on board with a screening process. Most will be, but some are hesitant to do so due to fear of litigation. 

I hope these tips on common mistakes school-based OTs make were helpful! Though I was guilty of some of these at first, I truly love practicing in the schools now. And I’m confident that you will, too. If you have any questions, I would love to have you join me in my Facebook group where I share videos and resources all about school OT. 

Looking to take your learning even further? My course, The Dynamic School OT, is a comprehensive course all about school-based OT. We’ll take an in-depth look at all of the topics discussed here, as well as evaluation, RtI, appropriate interventions, and how to manage difficult situations. Click here to learn more!

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