School-based OT is surrounded by much confusion and misinformation. Despite occupational therapy being an incredibly broad, holistic field, school-based OTs are often pigeonholed into roles as “handwriting specialists” or “fine motor therapists.” And what’s worse is when school-based OTs push back against these limitations, they are often met with resistance and told to “stay in their lane.” Let’s explore why this is such a common misconception – and what we can do about it.
What does IDEA say about School-Based OT?
When considering what falls into our domain in the schools, we should first look at the Individuals with Disabilities Education Act (IDEA), the federal law that governs special education and the main source of how OT functions in the school system.
IDEA defines OT as:
(i) Means services provided by a qualified occupational therapist;
(A) Improving, developing, or restoring functions impaired or lost through illness, injury, or deprivation;
(B) Improving ability to perform tasks for independent functioning if functions are impaired or lost; and
(C) Preventing, through early intervention, initial or further impairment or loss of function.”
Further, IDEA goes on to state that certain things related to OT must be included in an IEP:
“(4) A statement of the special education and related services and supplementary aids and services, based on peer-reviewed research to the extent practicable, to be provided to the child, or on behalf of the child, and a statement of the program modifications or supports for school personnel that will be provided to enable the child—
(i) To advance appropriately toward attaining the annual goals;
(ii) To be involved in and make progress in the general education curriculum in accordance with paragraph (a)(1) of this section, and to participate in extracurricular and other nonacademic activities;
(iii) To be educated and participate with other children with disabilities and nondisabled children in the activities described in this section;”
As you can see above, nowhere in the IDEA definition of OT does it refer to motor skills at all. So why have school-based OTs been pigeonholed into being fine motor therapists? The reasons probably have a lot to do with historical practice, lack of support/funding, and trying to adapt the medical model of OT to schools. What’s important to note is that both IDEA and AOTA (and likely your state laws too) support you utilizing your full scope of practice as an OT as long as it is related to the student’s education. That means we should be assessing and addressing way more than just fine and visual-motor skills.
What Do School-Based OTs Address Besides Fine Motor Skills?
Truthfully, we can address anything that is within the OT scope of practice. The difference is that in schools, our interventions must help a child benefit from their educational program. While we don’t work on academic skills like multiplication or biology, we do support pretty much all of the skills that go into being ready to learn about those things! Think things like:
- Activities of daily living
- Assistive technology
- Environmental modifications
- Executive function
- Fine motor skills
- Gross motor skills
- Leisure skills
- Rest and sleep
- Seating and positioning
- Sensory processing
- Social skills
- Visual-motor skills
- Vocational skills
School-Based OTs Support Educational Access
While OT can address all of the skills listed above, in the schools, it’s not enough for a student to simply have a deficit in one of these areas. Instead, there must be a demonstrated need that is related to that student’s access or independence with their educational program. You’ll often see this compared as the educational model vs the medical or clinical model. In the medical model, occupational therapy services can address any deficit area for the sake of remediating a deficit (as long as funding sources allow). While these often may end up being the same deficits, the difference is that in the school system, those deficits have to have educational impact.
To put it another way, in the medical model, pediatric OTs help their patients be the best tiny humans they can be in ALL of their roles. In the schools, OTs help their kids be the best students they can be.
And remember: this doesn’t mean that all of the things we address in schools are tied to academics. We all know that being a good student involves a lot more than just making good grades. So don’t forget to think of the other tasks your students need to do that require attention, executive function, sensory processing, emotional regulation, ADLs/IADLs, and vocational skills.
School-Based OTs Collaborate with Other Educators
Now, something else to keep in mind is that school-based OTs are not an island in the school system. Just because something falls into our scope of practice doesn’t mean that a student will require school-based OT services to address it. In fact, many of my school-based OT evaluations reveal areas of need that I recommend other professionals fulfill.
What does this actually look like in practice? Take handwriting – one of the most common OT referrals – for example. I might assess a student who’s struggling with handwriting. But through that assessment, I might find out that the student never had explicit handwriting instruction. I might also find that their underlying fine motor skills are actually pretty good. I might find that they tend to rush in class, but can write neatly when they slow down.
In these cases, I usually don’t recommend school-based OT services and instead put the ball back in the court of teaching staff. I educate my teams on how important it is to have explicit handwriting instruction and practice, and recommend some ways they can add this to the student’s routine. In some cases, I’ll even recommend a specific curriculum and offer to co-teach a lesson to orient the teacher and students. In these cases, the student doesn’t need OT intervention – they just need more opportunities to learn and practice.
Changing the Face of School-Based OT
If you’re a school-based OT working with people that think of you as a fine motor therapist or a handwriting teacher, you’re definitely not alone. And while it’s easy to get frustrated in these situations, try thinking of them as a learning/teaching opportunity. Here are some practical strategies to help your teams understand your full scope of practice:
- Offer to send them resources, such as the OT Practice Framework or your state’s guidelines for school-based OT
- Deliver inservices on the scope and benefits of school-based OT
- Consider pushing into the classroom for services so that teachers understand more about your role
- Refine your screening process and make sure teachers know they can come to you about concerns other than fine motor skills
- Share OT strategies with teachers via email
- Talk about all the ways in which you’re serving a student at their IEP meeting, and stay til the end
- When filling out IEP paperwork, don’t put everything into a section labeled “fine motor”
- Prep your school-based OT elevator speech to help explain your role to friends, family, and community members
- Create social media posts that highlight other areas you support as a school-based OT
- Respectfully correct people about your role when appropriate (“I love working on fine motor skills, but I’m supporting [Student] mostly for their sensory/emotional regulation needs!”)
- Share this article with your coworkers!
School-based OT is so much more than fine motor skills, and we all benefit when OTs step into a more holistic role. If you’re an OT who is looking to have your unique contributions valued and recognized, I’d love to have you in The Dynamic School OT Course. You’ll learn how to break out of the mold of being a fine motor therapist to become a highly valued, effective, and well-rounded provider in your school.