How to Qualify for OT in the Schools

Has someone ever asked you how to qualify for school-based OT? Navigating the intricacies of school-based occupational therapy can often feel like trying to solve a Rubik’s Cube in the dark. Between keeping up with the latest therapeutic interventions and understanding the dense forest of educational law, it’s no wonder even school-based OTs have trouble explaining when a student does qualify for occupational therapy.

Qualifying for School-Based Occupational Therapy

Let’s cut to the chase. You’re wondering how students qualify for OT in the schools. Well, spoiler alert: they don’t. 

Are you surprised to hear that? In school-based OT, the phrase “it’s complicated” is pretty much our unofficial motto.

Students don’t “qualify” for OT in the same way they do for special education. In school-based occupational therapy, we don’t operate with a magic list of federally-decided qualifying scores or neatly defined boxes into which students must fit. Instead, we exist in the grey area, assessing whether a student requires OT to access their education effectively.

Who Requires School-Based OT?

As much as every student could benefit from OT, the guiding principle is not whether OT would be nice to have, but whether it is essential for a student to access their education. This crucial distinction means peeling back the layers of a student’s school experience to uncover if and how their educational journey is being hindered by challenges that fall within the OT’s realm of expertise.

When we consider recommending OT services, it’s not about qualifying scores, akin to those for special education. Instead, our compass is whether a student can engage with their education in a meaningful way. For example, if tactile sensitivity is more than just a nuisance—if it’s a barrier that prevents a student from participating in classroom activities or social interactions—then, yes, we’re talking about a need for OT intervention.

Requiring OT to access education implies that there’s a gap between what the student can currently manage and what they need to be able to do to thrive in a school setting. This could be mastering the fine motor skills needed for writing assignments, navigating the sensory overload of a bustling classroom, or managing transitions and organizational tasks. 

And because we’re a related service only in most states, it also means that what we do as school-based OTs can’t be duplicated by someone else on the special education team. Always keep the least restrictive environment (LRE) in mind: could a general education teacher implement these strategies? Could a special education teacher? Could a paraprofessional do so after some consultative OT? These are all questions you should be asking yourself anytime you recommend OT services. 

Evaluations for School-Based OT

In order to say “This student requires school-based OT,” a thorough school-based OT evaluation is necessary. This evaluation is a crucial process that assesses a student’s functional abilities and identifies how specific challenges may be obstructing their educational access and success. Through assessment tools alongside detailed observations, OTs can discern the nuanced ways in which a student’s self-help skills, sensory processing, fine motor skills, or social-emotional capabilities impact their learning. It’s this in-depth understanding that allows us to advocate for OT services as a necessity, not just an enhancement, for a student’s education. 

how to qualify for school-based OT

IEPs, 504 Plans, and More

In special education, the Individuals with Disabilities Education Act (IDEA) is our guiding star, ensuring every child has the right to a Free and Appropriate Public Education (FAPE). This act sets the stage for Individualized Education Plans (IEPs), where OT enters the chat if a student requires our services to benefit from their education.

But here’s the catch: a student must first qualify for special education under one of IDEA’s 13 eligibility categories. Only then can OT be delivered through an IEP.

However, there is another type of situation where OT may be available: 504 plans. Section 504 of the Rehabilitation Act addresses discrimination based on disability for institutions that receive federal funding, like schools. The interaction between these laws is somewhat complex, but long story short: some students may qualify for a 504 plan but not an IEP. 504 plans are typically where accommodations and modifications come into play versus goals and direct services. However, OT services under a 504 plan are still possible and in some cases, legally required.

What many people don’t realize is that students don’t have to have an IEP or a 504 plan to receive school-based OT. These laws are more about what to do in the case of a student with an educational disability, and don’t really comment on students that don’t meet those criteria. 

So, your school district may be willing to allow you to serve a student who doesn’t have either of these plans. This is just less likely because our positions are usually funded through special education and school districts don’t often have a lot of extra dollars sitting around allowing them to go above and beyond what is legally required. But it’s possible, so if you find yourself in this situation, make sure that you’re keeping up with all of the other legal requirements of providing OT in your state. It’s important to read your state OT practice act to see what this specifically entails, but it will likely be an OT evaluation + treatment plan at the very least.

State Special Education Law

While IDEA and Section 504 must be upheld nationally, some states go further and write their own laws around special education and disability. In these states, you may find specific qualifying scores for services like occupational therapy. What’s important to remember here is that those laws likely have exceptions, and that IDEA supersedes any state law that might be in conflict. 

In practice, what this might look like is recommending OT services for a student who performed well on a standardized test but is falling apart in the classroom. Or, it may be you recommending against services for a student who hasn’t made progress in therapy for years but likely will always score below average on a standardized test.

Long story short: the decision to provide school-based occupational therapy services should always be individualized and based on multiple factors, even if your state has identified specific scores to guide your decision. 

A Note on the Medical Model

As a school-based OT, I’ve sometimes found myself in the frustrating situation of a family bringing in a referral from a pediatrician or outpatient OT that states a student requires OT at school. However, the distinction between school-based OT and medical model OT is pivotal, rooted in fundamentally different objectives. School-based OT is uniquely focused on supporting a student’s ability to participate and succeed in the educational environment, emphasizing adaptations and interventions that facilitate access to learning and school participation. On the other hand, the medical model of OT targets clinical diagnoses, aiming to remediate or rehabilitate medical conditions, often in settings like hospitals or outpatient clinics. This fundamental difference is why a doctor’s prescription or an outpatient OT’s recommendation doesn’t automatically translate to school-based OT services. 

how to qualify for school-based OT

In the educational setting, the determination for OT services hinges on the specific impact of a student’s challenges on their educational performance, not solely on a medical diagnosis. It’s about whether the student requires OT to access their education effectively, ensuring interventions are directly tied to educational success, rather than broader medical or developmental needs not related to their schooling. 

As we wrap up this journey through the labyrinth of how to “qualify” for OT in the schools, remember: this is a grey area that requires your unique expertise and clinical reasoning every time. While it would be easier to say that a score on a test that was 2 standardized deviations below average means a student gets school-based OT, it is a much more meaningful decision. Our mission is to ensure that every child can navigate the educational landscape with the right supports for their individual case. 

Want to learn more about when to recommend OT services in the school system? My course, The Dynamic School OT, is the perfect resource for any therapist looking to become a more effective and confident school-based OT. We’ll take an even more in-depth look at evaluation and recommending services, as well as intervention, time management, and more. Click here to learn more!

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