School-Based OT Myths

School-based OT can be pretty confusing. With all of the different laws and regulations that intersect with each other, it can be overwhelming to learn how to practice in this setting. And unfortunately, sometimes this confusion leads to the development of myths. Some of these come from well-meaning administrators who don’t fully understand the role of school-based OT. Some may be from OTs who have never worked in this setting. But do you know the biggest source of school-based OT myths? Other school-based OTs. 

I can’t count how many times I’ve seen other school-based OTs purporting and spreading these myths as though they were fact. It’s not usually done with bad intentions. Often these come from OTs who have only worked in one district, in one state, and don’t realize that the things their supervisors and coworkers have told them may not be fully true. This is one reason I’m glad to have worked for so many different districts as a travel therapist – you very quickly learn what is federal law, what is state law, and what is just status quo at a district because “it’s how we’ve always done it.”

So, ready to bust some myths? I know many of these are something I believed at one stage in my practice!

School-based OTs are limited to addressing fine motor skills

This one is so interesting to me because 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? I’m not sure, but it’s important to note 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 way more than just fine motor skills, visual-motor skills, and sensory processing. 

OT can’t be a standalone service on an IEP

This one is super tricky because in most states, this is true as OT is a related service. But in some states, like Washington, OT can actually serve as Specially Designed Instruction (SDI), which means that it actually can standalone on an IEP. This one was super hard for me to wrap my head around when I first started practicing in Washington because it had been so drilled into my head by other therapists that there is no situation in which OT would ever be the only service on the IEP. And more than likely, they were completely correct – for their location. Which brings me to my next point…

School-based OT looks the same in every state 

Yes, school-based OT is federally mandated by IDEA, and federal law tends to trump state law when there is a conflict. But the part where it gets tricky is where some states choose to define things further. IDEA overall is actually a pretty vague law, so you will find that various states and districts can have different interpretations. Some states will even make this official by making their interpretations into state laws. Which is how you get OT as SDI in Washington – there’s nothing in IDEA that says OT CAN’T be SDI, so WA decided to expand on the services offered to their students.

Beyond just special education law, you’ll find differences in how OTs are categorized in the school system – are they certificated or classified? Are they in the teacher’s union or a separate one? Can they advance to admin positions? All of these impact the experience of being a school-based OT. So, keep in mind if you’ve only practiced in one state – and especially if you’ve only practiced in one district – that your experience as a school-based OT may not be universal. 

OTs can’t case manage

This is another one I hear commonly, but it’s totally untrue! OTs can and do case manage in the school system, though it’s more likely in states where OT can be a primary or standalone service. But truthfully, this is another area that is not well-defined in IDEA. Nothing in the federal law says that a case manager has to be a special education teacher, or that they can’t be an OT. Some states may further define the role, but even this is rare. Usually, this is an area that districts decide how to handle on their own. Now, in practice, I think it’s rare that an OT will be the most appropriate case manager for a student – but these situations do happen. And when they do, OTs often have the experience and expertise needed to be effective case managers. 

Changing a student’s grasp to dynamic tripod will lead to increased legibility

As much as you will hear about the dynamic tripod grasp in the school system, there has never been a research study that shows this is the most effective grasp. More than that, there’s never been a research study that shows that attempting to change a child’s grasp leads to increased legibility – and anecdotally, I’ve usually found the opposite to be true. Now, there may be other reasons to attempt to change a grasp, usually revolving around pain or fatigue. But even still, we should ensure we’re only providing this type of intervention when the student is motivated and interested in changing their grasp – not when they’re being forced. 

Students must score low on a standardized test to receive school-based OT

This is one I see therapists from medical settings getting hung up on sometimes. There are no qualifying scores for school-based OT, though some states have tried to put a more stringent rubric in place. While standardized tests can certainly be part of your assessment process, they should never be the sole determining factor in whether a child requires school-based OT or not. Instead, we must use multiple measures to determine if a student is educationally impacted. This means that sometimes a student might score high on a standardized test but still require school-based OT. It also means that the opposite is true, too – some students will score low on standardized testing but do not require school-based OT to access their education. 

Students don’t need school-based OT after elementary school

This is another one I heard and partially believed until I started working in a high school district. Before I accepted this position, I was worried that I would have a caseload full of students who should have been discharged years ago. And while there were some students who no longer required the service, there were many more who still needed school-based OT to support in the areas of transition, vocational skills, executive function, and assistive technology. Yes, goals, service delivery models, and intervention approaches should look different beyond elementary school. But that doesn’t mean there aren’t middle and high schoolers out there who require the service. 

School-based OTs can’t do RtI

RtI, or Response to Intervention, is a framework that allows all students to receive the support they need, whether they have been identified as requiring special education or not. This support can look a lot of different ways, from in-services and teacher trainings to time spent directly with students. States handle their RtI practices differently (you may also hear of a similar model called MTSS), but ultimately, if your district is providing RtI, OTs can and should be a valued part of that process. 

Working off the clock is unavoidable 

This is another one I hear often from therapists – that there is no way to do their job without taking work home, working past contract hours, or working on school breaks. But guess what? I’ve done it over and over again working as a travel therapist in multiple districts. This isn’t to say that my assignments have all been a cakewalk. I’ve been stressed, overwhelmed, and exhausted. I’ve carried caseloads that were way too high. I’ve made up a semester’s worth of compensatory time alongside all of my regular duties. But one boundary I have never backed down from is working off the clock. No, it’s not always easy, and it does often require conversations with your supervisor. But it is so necessary for your longevity and energy in this role. 

OTs can’t serve students on 504 plans

While it is less common, a student on a 504 plan may require related services such as occupational therapy. This may take the form of an OT helping develop accommodations, consultative services, and in rare cases, direct services. It’s important to note that Section 504 is a facet of general education. Since no special education funds can be used for general education programs, many districts state that they will not allow related services such as OT on 504 plans not because they have a legal basis for doing so, but because this allows them to save money.

Because of school-based OT myths like these, it’s important to always use critical thinking when getting answers to your questions. Get information from sources you trust, and don’t be afraid to ask them where you can read more about the law/regulation/research they’re using to inform their conclusion. A good mentor should always be happy to point you in the direction of further reading to support your practice. 

Are you looking for more support with having an informed and legally compliant OT practice? I’d love to have you join me in my signature course, The Dynamic School OT. If you’ve been looking for a way to make your school-based OT practice more evidence-based, meaningful, and effective, this is the perfect fit!