School-based occupational therapy has shifted in recent years to focus on a more collaborative and contextual approach. One example of this is providing “push-in” occupational therapy services in the natural environment, such as a student’s classroom, cafeteria, or playground. This runs in contrast to a more traditional model of “pull-out” occupational therapy services, where a student or small group of students are taken to a separate room to receive therapy. While there are many benefits to updating to this model, in practice there exist some barriers to implementation. Some of these barriers are complex and challenging to navigate, however, some of these barriers relate to the OT’s own biases and perceptions. It is eternally important to engage in self-reflection in our practice, so if you find yourself feeling uneasy about shifting to a more contextual and collaborative model of service, make sure you’re not falling prey to these common myths about push-in OT!
Teachers don’t want OTs to push-in to the classroom.
Starting to deliver services in the classroom can be intimidating, especially if your teachers are used to a pull-out model. Some OTs have the perception that teachers don’t want OTs in the classroom, and while this may be true for a select few at first, I’ve found that most teachers are very open to this sort of support. In fact, in a 2020 study entitled “General Education Teachers’ Perspectives on Collaboration With OTs in the School Setting,” they found that collaboration with OTs was valued by 85.1% of respondents. Anecdotally, this matches my experiences as well at a variety of school districts spanning multiple states. Teachers are grateful for our help! Teachers have to be “on” all day in a way we don’t as OTs, and having another adult in the classroom to help deliver support can help immensely. Plus, think of all of the other adults that might show up besides a classroom teacher – paras, administrators, instructional coaches, volunteers, guest speakers, school counselors, librarians, etc. A school-based OT is likely not the first person a teacher has visit their classroom.
While it’s likely that you will encounter some teachers who will be resistant to the idea of you being their classroom, in my experience, it’s been a minority. Start small with the teachers you already have good relationships with, and soon enough all of your teachers will be champing at the bit for you to come support their classroom!
Push-in OT services don’t address the student’s goals or needs effectively.
I hear this a lot, and my first piece of advice is to always take a critical look at the goals and needs you’re supporting. If those things aren’t coming up in the classroom, is it truly a relevant goal for the student? This is a big reason why it’s so important to collaborate with teachers when writing IEP goals – we want to make sure the things we’re focusing on will actually support the student with what they’re doing in the classroom. After this, it’s all about scheduling. If you need to work on writing with a student, make sure you are scheduled at a time when the class is typically writing! There are kinks to work out with this, especially at first, as teachers sometimes change their schedule on the fly. However, don’t let one or two “bad” sessions make you feel like push-in is futile. The longer you work collaboratively with the teacher, the more they’ll understand what kind of tasks you need to see when you’re in the classroom. I’ve found that most teachers are incredibly flexible once they realize how limited my time is.
Scheduling makes push-in OT services impossible.
And of course, this takes us to the next myth – that our schedules simply cannot support push-in services. And while it is true that scheduling is a huge barrier to providing effective push-in services, it is possible. This is also a great opportunity to take a critical look at our practice. If your caseload is so high that you have to see kids in pull-out small groups just to get all of the service time in, there are larger red flags in your practice that need to be addressed. This is easier said than done, but if your workload is so high that you can’t see kids individually in the classroom, then it’s time to talk to your admin about what reasonable expectations for your role are. And no, this is not something where you can snap your fingers and expect overnight change. But even in a district where I had a caseload of 72 across 7 schools, I was able to advocate to admin for a more reasonable workload and eventually start seeing all of my students in their classrooms.
Push-in OT embarrasses the student.
This is another one I hear frequently, and while I won’t say it’s never true, I want to caution OTs to make sure this isn’t something we’re assuming. Yes, OT in the classroom may embarrass some students. But anecdotally, I can count on one hand the number of students who have said this to me, across a caseload of preschoolers all the way to 18-22 post-secondary students. Sometimes, we’re putting our own biases on students even if it has little to do with how they actually feel. Your student’s classmates likely already realize that your student is struggling with some aspect of school. The difference is, they may still be young enough that they don’t have those same negative connotations that we do. Plus, the alternative is that your student leaves the classroom for your service – so their classmates realize that something is up, whether it happens in the classroom or not. Remember that many other adults visit a classroom in any given week and that your presence likely isn’t as unusual to them as you might think. And if you do have a student that you think might be embarrassed about being singled out, ask them what they’re comfortable with! I also find that being a more global support and floating around the classroom to work with all of the students, not just my own, is a type of push-in support that works well for older grades.
Push-in OT services are too distracting for the student.
Another thing I hear often from school-based OTs is something like this: “I’d push in more, but they’re just so distracted in the classroom! They learn the skill so much more effectively when we’re in the 1:1 environment of the therapy room.” And on the surface, this totally makes sense, right? But when you explore it more deeply, what do you think happens in class the rest of the time? Are they magically not distractible? Or are they likely struggling to pay attention during the times when you’re not there, too? As an OT, you are an expert in attention, executive function, participation, and modifying the environment. If you have a student who can’t pay attention in class, then one of your number one priorities should be figuring out how to help! Your student’s number one job is to learn, and your creative brain is there to help the team figure out what that looks like for your student. This will be so much more valuable for your student and their teachers in the long run than pulling them out to do a fine motor craft.
Push-in OT is disruptive to the rest of the class.
This is something I usually hear from OTs who have tried pushing in once or twice but didn’t feel successful. And yes, while the rest of the students may make a big deal about you at first, once you’re in a routine, your presence will become commonplace. I also love the opportunities push-in OT affords like co-teaching, which can benefit all students. Plus, being involved with the rest of the students in the class allows you to keep an eye on students who may be struggling but not yet referred to special education.
You can’t build a therapeutic relationship with push-in OT services.
This is a fear I’ve heard from OTs, but honestly, it’s unfounded. There are students in my career who I’ve never seen in a therapy room. And gosh, those relationships still go so deep! In some ways, I feel like they can go even deeper. You get to see how your student interacts around other people, and sometimes even help them bridge social connections with their peers. Plus, what better way to build a therapeutic relationship than playing on the playground? For any OT who is worried that they won’t be able to build a relationship with a kid if they don’t see them in a separate setting, I promise I still get cards, sweet notes, drawings, and hugs from the kids I’ve supported exclusively in the classroom.
Push-in OT is lazy.
This one is wild to me, but yes, this is a real piece of feedback I received from another OT when sharing why school-based OTs should push in! Push-in OT is not lazy, though it may require a different set of skills than we are used to. But I assure you, it would be much easier to write a schedule where students just come to my therapy room at a time I dictate. Working collaboratively with teachers to find the ideal time for me to push in to their classroom – for each student on my caseload – takes a LOT of time and effort. And once the services are being delivered, I find I have to have a way more active brain in the classroom than I do in a private session. In the classroom, my brain is constantly doing activity analysis, thinking of how to modify work, and filtering all of the other things that are going on. And after the session, my brain is spinning with things I want to create for my student based on what I observed. Compared to a session where you plan 1-2 crafts and then do them with your entire caseload for a week, I find push-in OT to be much more engaging and effortful – in the best way.
While it can be challenging to shift to a contextual and collaborative model of service at first, don’t let these myths about push-in OT stand in the way of becoming the best school-based OT you can be. We support our students in having a growth mindset, and part of that means recognizing when our own fixed mindset is getting in the way of growing, changing, and improving. And if you’ve been feeling like you want to make a shift to this model of service but just don’t know how to get there, I’d love to have you in my signature course, The Dynamic School OT. It goes beyond theory and teaches you actual, actionable strategies for providing meaningful, evidence-based OT services in the classroom. See you there!